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Critical Care |

Get to the Point: A 44-Year-Old Female Presents to the Emergency Department With Chest Pain

Patrick Smith, DO; Michael Perkins, MD
Author and Funding Information

National Capital Consortium (Walter Reed) Program, Washington, DC


Chest. 2014;146(4_MeetingAbstracts):331A. doi:10.1378/chest.1959165
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Abstract

SESSION TITLE: Miscellaneous Case Report Posters II

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Chest pain is one of the most common complaints encountered in the emergency department. We present an unusual case of chest pain in a young, healthy female.

CASE PRESENTATION: A 44 year-old female with history of lumbago reported to the emergency department (ED) with complaints of chest pain shortly after she was treated with acupuncture in the internal medicine clinic. This was the patient’s second acupuncture session for treatment of her lower back pain, which consisted of inserting needles into her scalp, neck, and lumbar paraspinal region. However, 1 hour after the treatment, the patient began experiencing right-sided chest pain with accompanying dyspnea. A chest X-ray obtained in the ED demonstrated a 2.1 cm right-sided apical pneumothorax which was enlarged on a follow up CXR obtained two hours later. The patient remained hemodynamically stable. An aspiration was performed with removal of 150 mL of air. A small pneumothorax remained after the procedure and she was admitted for observation. The pneumothorax resolved on hospital day 2 without any additional intervention.

DISCUSSION: Acupuncture is an alternative medicine procedure that has been practiced in China for more than 2000 years, and has been gaining in popularity in the United States since the 1970’s. Pneumothorax has been identified as an adverse event associated with this procedure. However, pneumothorax following acupuncture is extremely rare, with one study reporting only 2 occurrences out of 2.2 treatment sessions in approximately 230,000 patients. Despite its extremely low incidence, pneumothorax associated with acupuncture can be fatal. We believe that our patient’s pneumothorax is a direct consequence of acupuncture. The pneumothorax was located on the same side of her treatment and there was a close temporal relationship to the onset of symptoms. Our patient had a thin chest wall (BMI of 18), which may have increased the risk of puncturing the pleura during the acupuncture sessions.

CONCLUSIONS: We present a rare case of an iatrogenic pneumothorax following the administration of acupuncture. Although infrequent in occurrence, all health care providers should be fully aware of this potentially life threatening adverse event from the administration of this alternative therapy.

Reference #1: Stenger M, Bauer NE, Licht PB. Is pneumothorax after acupuncture so uncommon? J Thoracic Dis 2013;5(4): E144-E146.

Reference #2: Olusanya O, Mansuri I. Pneumothorax following acupuncture. JABFP 1997;10(4): 296-297.

DISCLOSURE: The following authors have nothing to disclose: Patrick Smith, Michael Perkins

No Product/Research Disclosure Information


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