Enteral feeding is now standard therapy for many patients who are unable to eat because of difficulties with swallowing or because of major medical or surgical disorders. In the short term, this is usually given through nasogastric tubes but, in the longer-term, some patients are more easily managed by percutaneous endoscopic gastrostomy (PEG). As nasogastric tubes of standard diameter (12–14 French) are uncomfortable for many patients, it is now common practice to provide enteral feeding through small diameter (fine-bore) tubes. In general, these fine-bore tubes are more difficult to pass into the stomach, although at least some brands have guide-wires that facilitate passage by stiffening the tube. Fine-bore tubes are also associated with increased risks for placement of the tube into the lung, blockage of tubes by enteral feeds and displacement of the tubes by retching or regurgitation. The administration of enteral feeds into the lung is associated with substantial mortality in patients with serious coexisting disorders. Techniques that have been adopted to confirm the position of the tube include insufflation of air through the tube and auscultation in the epigastric area as well as aspiration of gastric juice that normally has a low pH. However, radiological confirmation of the position of the tube should always be performed if the position of the tube is in doubt. In some hospitals, this has been adopted as policy since incorrect positioning of the tube can have medicolegal implications. The chest radiograph in Fig. 1 was from a 74-year-old man who was admitted to the Intensive Care Unit with respiratory failure. He was unwell with septic arthritis and, some hours previously, had a nasogastric tube inserted because of malnutrition and difficulty with eating. The chest radiograph shows the nasogastric tube in the right middle lobe bronchus with pneumonitis of the right lower lobe. Malpositioning of the tube was confirmed by laryngoscopy prior to the placement of an endotracheal tube. Although chest radiographs usually provide definitive confirmation of the position of the tube, unusual settings can occur as shown in Fig. 2. In this case, the tube appears to be curled in the lower chest (arrows). The reason for this unusual position was that the tube was curled in a large sliding hiatus hernia. In such situations, endoscopy may be required to position the tube below the diaphragm.