Introduction Acupuncture is usually portrayed as a risk-free therapy; but is it? We report a case of a tension pneumothorax following acupuncture therapy.
Case Presentation A 70 year-old-man was receiving acupuncture therapy for right-sided post-herpetic neuralgia involving the 4th–7th intercostal nerves. Shortly after, he started complaining of severe dyspnea and pleuritic chest pain and was transferred to the emergency department. His SpO2 was 77% on room air, respiratory rate 38/min, heart rate 129/min and blood pressure 154/82 mm Hg. Absence of breath sounds was noted on the right side. Chest X-ray (CXR) revealed a right-sided pneumothorax with mediastinal shift (figure 1). A 14F chest tube was placed and a follow-up CXR showed resolution of the pneumothorax. On hospital day#2, the air leak resolved and the chest tube was clamped, but the patient developed subcutaneous emphysema requiring unclamping of the chest tube and attaching it to suction (–40 cm H2O). On day#4, the chest tube was removed. Serial CXRs were done showing stable subcutaneous emphysema and absence of pneumothorax. He was discharged home on day#7 only to be readmitted 48h later with recurrent pneumothorax requiring placement of another 14F chest tube. Due to persistent air leak on suction, a chest CT was done showing small anterior right-sided pneumothorax and right-sided subpleural bullae (figure 2). Thoracic surgery was consulted and a Video-assisted thoracoscopic excision of ruptured bullae with talc pleurodesis was performed. He was discharged home on hospital day#13. At one month follow-up, he remained asymptomatic.
Discussion Acupuncture is one of the most popular of all alternative therapies, and is a relatively safe procedure. Although rare; pneumothorax is the most reported serious complication. In a prospective observational study in Germany, the incidence of acupuncture-related pneumothorax was 1/100000 patients (1). Unfortunately, this study included various acupuncture treatments and not only the ones where needling of the thorax occurred.
High quality studies are absent and most data come from case reports. In a review of the Chinese literature, 30 cases were reported between 1980 and 2013(2). In the English literature, 26 cases were reported between 1965 and 1999(3), and 13 cases between 2000 and 2011, with only 3 cases in the USA(4).
Most reported cases have in common the lack of an informed consent. We are reporting this case to increase the awareness toward recognizing pneumothorax as a potential complication of acupuncture, and reinforce the need of an informed consent where benefits and risks of acupuncture therapy are discussed⇓.
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