{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T03:11:45Z","timestamp":1759461105232,"version":"build-2065373602"},"reference-count":18,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100030902","name":"Martin-Luther-Universit\u00e4t Halle-Wittenberg","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100030902","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Forensic Sci Med Pathol"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Purpose<\/jats:title>\n            <jats:p>This case report highlights a rare but fatal complication of artificial enteral nutrition due to feeding tube misplacement, leading to pleural effusion and respiratory failure. The primary objective was to determine whether enteral nutrition formula leakage contributed to the patient\u2019s death and to differentiate the pleural effusion from other possible etiologies, such as chylothorax.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A 59-year-old male patient with severe lung disease underwent left-sided partial lung resection and subsequently received enteral nutrition via a nasogastric feeding tube. After suspected feeding tube misplacement and formula leakage into the pleural cavity, autopsy and histological examination were performed. Cytological and chemical analyses, including gas chromatography-mass spectrometry, were employed to identify nutritional components in pleural effusion and to confirm the presence of enteral nutrition formula.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The autopsy revealed milky, turbid pleural effusion, aspiration pneumonia, and a rupture of the right visceral pleura. Cytological analysis confirmed granulocytic pleural empyema with rod-shaped Congo red-positive material resembling the enteral nutrition formula. Gas chromatography-mass spectrometry identified tricaprylin, a unique marker for enteral nutrition formula, confirming nutritional leakage into the pleural cavity.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This case study emphasizes the necessity for radiological confirmation of feeding tube placement and the implementation of comprehensive diagnostic protocols for suspected cases of nutritional fluid leakage. Gas chromatography-mass spectrometry proved invaluable in distinguishing nutritional effusions from other potential etiologies by enabling the specific identification of enteral formula components. The high specificity and adaptability of gas chromatography-mass spectrometry render it an essential tool for forensic investigations and clinical diagnostics involving complex fluid analyses, facilitating evidence-based conclusions in critical care and postmortem contexts.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12024-025-00982-0","type":"journal-article","created":{"date-parts":[[2025,3,22]],"date-time":"2025-03-22T18:41:37Z","timestamp":1742668897000},"page":"1287-1295","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["An alternative method to differentiate pleural effusion after leakage of artificial enteral nutrition formula"],"prefix":"10.1007","volume":"21","author":[{"given":"Fabian","family":"Picht","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Bl\u00fcmke-Anbau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Richter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6666-0592","authenticated-orcid":false,"given":"Marco","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"issue":"2","key":"982_CR1","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1177\/0148607115621863","volume":"40","author":"SA McClave","year":"2016","unstructured":"McClave SA, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine (SCCM) and American society for parenteral and enteral nutrition (A.S.P.E.N). JPEN J Parenter Enter Nutr. 2016;40(2):159\u2013211.","journal-title":"JPEN J Parenter Enter Nutr"},{"issue":"9","key":"982_CR2","doi-asserted-by":"publisher","first-page":"1671","DOI":"10.1016\/j.clnu.2023.07.011","volume":"42","author":"P Singer","year":"2023","unstructured":"Singer P, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr. 2023;42(9):1671\u201389.","journal-title":"Clin Nutr"},{"key":"982_CR3","doi-asserted-by":"publisher","first-page":"e3400","DOI":"10.1590\/1518-8345.3355.3400","volume":"29","author":"APG Motta","year":"2021","unstructured":"Motta APG, et al. Nasogastric\/nasoenteric tube-related adverse events: an integrative review. 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Open Access Emerg Med. 2012;4:31\u201352.","journal-title":"Open Access Emerg Med"}],"container-title":["Forensic Science, Medicine and Pathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12024-025-00982-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s12024-025-00982-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12024-025-00982-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T02:57:13Z","timestamp":1759460233000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12024-025-00982-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,21]]},"references-count":18,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["982"],"URL":"https:\/\/doi.org\/10.1007\/s12024-025-00982-0","relation":{},"ISSN":["1556-2891"],"issn-type":[{"type":"electronic","value":"1556-2891"}],"subject":[],"published":{"date-parts":[[2025,3,21]]},"assertion":[{"value":"5 March 2025","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 March 2025","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors consulted the institutional ethics committee to assess the ethical requirements for this study. According to Article 15 of the Medical Code of Conduct, ethical review is required only for research involving data or samples that can be assigned to a specific individual. As this case report presents findings from an officially ordered autopsy conducted as part of routine clinical practice, it does not constitute biomedical research on humans requiring ethical approval. Additionally, the guaranteed anonymity of the case ensures that post-mortem personal rights are adequately protected. Consequently, ethical advice was deemed unnecessary and not institutionally mandated for this study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Conduct"}},{"value":"All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or nonfinancial interest in the subject matter or materials discussed in this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}