A care of oesophageal perforation and aspiration of a pleural effusion by a narrow bore nasogastric tube is reported. The presence of cardiac enlargement was thought to be a precipitating cause. It is suggested that insufflation of air with auscultation over the epigastrium and aspiration of narrow bore tubes, as well as chest X-ray, should be carried out routinely to establish the position of such tubes prior to commencing feeding.