Disorders of the Pleura |

An Unusual Cause of Pneumothorax: Acupuncture FREE TO VIEW

Meera Yogarajah, MD; Bhradeev Sivasambu, MD; Divya Salhan, MD
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Interfaith Medical Center, Brooklyn, NY

Chest. 2015;148(4_MeetingAbstracts):448A. doi:10.1378/chest.2259897
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SESSION TITLE: Disorders of the Pleura Student/Resident Case Report Posters

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM

INTRODUCTION: Acupuncture is a component of traditional Chinese medicine which is primarily used for pain relief. It is a relatively safe procedure in an experienced hand yet there have been many complications attributed to acupuncture. We report a case of secondary pneumothorax that developed few hours after acupuncture therapy.

CASE PRESENTATION: A 49 year old female presented to the emergency department for sudden onset shortness of breath for 2 hours. She had acupuncture therapy for her neck and back pain 3 hours ago. Acupuncture needles were inserted on side and back of her neck. She was well that morning and denied any other symptoms including cough, fever or chest pain. Her other medical problems were human immunodeficiency virus infection and her last CD4 count was 160, ischemic stroke with no residual weakness, coronary artery disease, breast cancer and bronchial asthma. Physical examination revealed respiratory distress and her pulse rate was 83 per minute, blood pressure was 115/73 mm/Hg, respiratory rate was 24 breaths/min and saturation was 93% on room air. Respiratory system examination was significant for hyper-resonant left chest with markedly diminished breath sounds. Pneumothorax was suspected clinically. Chest X-ray confirmed a large left-sided pneumothorax with collapse of the left lung without shifting of the mediastinum. Urgent tube thoracostomy was performed in emergency department. Her initial labs were normal. Air leak resolved in 48 hours and chest tube was removed. Patient was discharged home on the following day

DISCUSSION: Acupuncture can lead to numerous complications though rare in the hands of an expert. The commonest complication is infection associated with use of unsterilized needles followed by internal organ damage. Sound anatomical knowledge on the acupuncture landmarks will prevent complications and thus cannot occur when performed by an expert. Pneumothorax occurs when the needles are placed in parasternal or supraclavicular site without taking in to account that the borders of the pleura and lung are situated well above the clavicles. Acupuncture to the paravertebral, infra-clavicular and lateral thoracic regions may also cause pneumothorax. Other reported complications are bilateral hand edema, epithelioid granuloma at needling sites, pseudolymphoma, localized argyria, pustules, pancytopenia, and scars at needling sites.

CONCLUSIONS: Although pneumothorax after acupuncture is rare, identifying pneumothorax after acupuncture can be lifesaving and this case was written in the intent of creating awareness of acupuncture related pneumothorax.

Reference #1: He W, Zhao X, Li Y, et al. Adverse events following acupuncture: a systematic review of the Chinese literature for the years 1956-2010. J Altern Complement Med 2012;18:892-901

DISCLOSURE: The following authors have nothing to disclose: Meera Yogarajah, Bhradeev Sivasambu, Divya Salhan

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