Case Report

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American Journal of Emergency Medicine

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The acupunctured lung

American Journal of Emergency Medicine 32 (2014) 111.e1

Abstract

We discuss a 72-year-old woman admitted with acute shortness of breath and severe sharp chest pain several hours after receiving acupuncture therapy. She was subsequently diagnosed as having an iatrogenic pneumothorax secondary to acupuncture. We discuss the complications of acupuncture and why patients should be informed of the risks of such procedures.

A 72-year-old woman with a background of chronic obstructive airways disease on home nebulizers and Chronic back pain was admitted to our emergency department. She complained of acute shortness of breath and severe sharp pain on the left side of her chest. She had received acupuncture 5 hours previously and had noted a severe pain with the insertion of 1 needle in her back. She had been

Fig. Chest radiograph demonstrating left-sided pneumothorax.

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undergoing weekly acupuncture sessions for her chronic back problems.

A chest x-ray confirmed a left-sided pneumothorax (Fig.). Her blood tests were unremarkable, and a 12-lead electrocardiogram demonstrated sinus tachycardia. A 12F chest drain was inserted into the 5th intercostal space in the posterior axillary line using the Seldinger technique. There were no complications related to the procedure. A repeat chest x-ray confirmed that her lung had fully reexpanded, and she was discharged home 2 days later.

Acupuncture originated in China in approximately 1600 to 1100 BC [1]. It is among one of the most popular alternative procedures involving penetrating the skin with needles. The style of acupuncture varies. The Chinese style of acupuncture involves inserting needles deep into the muscle; however, the Japanese method involves insertion into the subcutaneous tissues [2].

Given its invasive nature, it does not come without risks. Pneumothorax is rare, occurring twice in only a quarter of a million patients [2]. There has been a recent case report of a bilateral pneumothorax secondary to acupuncture [3]. The most common site for pneumothorax is the medial scapular or midclavicular line where the lung surface marking is approximately 10 to 20 mm [4]. Other serious adverse events include spinal cord injury, hepatitis B, and cardiac tamponade [2].

We feel that our case highlights the importance of complications of alternative therapies. Patients must be fully informed of the consequences that may occur, as in our unusual case.

Nerys Conway MBBCh Shiva Sreenivasan MBBS

Department of Acute Internal Medicine Gloucestershire Royal Hospital

GL1 3NN Gloucester United Kingdom

E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2013.08.026

References

1. Robson T. An introduction to complementary medicine. Gloucester, UK: Allen & Unwin; 2004.
2. Saifeldeen K, Evans M. Acupuncture associated pneumothorax. Emerg Med J 2004;21:398.
3. Tagami R, Moriva T, Kinoshita K, et al. Bilateral Tension pneumothorax related to acupuncture. Acupunct Med 2013 Jun;31(2):242-4.
4. Peuker ET, White A, Ernst E, et al. Traumatic complications of acupuncture. Therapists need to know human anatomy. Arch Fam Med 1999;8:553-8.