A 77-year-old woman presenting with severe acute ischaemic stroke failed a swallow screening test on admission.A nasogastric (NG) tube was inserted to initiate enteral feeding.She required multiple NG tube placements due to agitation with repeat malposition Ramen Bowl into the right bronchus Plastic Idler Pulley demonstrated on chest radiographs.
Further radiographs to confirm NG tube position showed a right apical pneumothorax that was missed on initial imaging reviews.The patient remained clinically stable with no respiratory compromise and the pneumothorax resolved spontaneously without directed treatment.