Iatrogenic Pneumothorax From Acupuncture

Abstract

Case report: A 27-year-old man experienced right chest pain immediately after acupuncture to his upper back. On examination, his oxygen saturations were 98% at room air, with a respiratory rate of 16/min. His right chest was hyper-resonant on percussion, with reduced air entry on auscultation. A chest x-ray showed a right pneumothorax with an apex to pleural distance of 41 mm. The patient was admitted for observation, with reduction in the size of the pneumothorax on interval chest x-ray. He was discharged after 3 days and follow-up imaging 3 weeks later showed complete resolution of the pneumothorax. Discussion: Acupuncture is rising in popularity in New Zealand. Proponents claim benefits for a wide range of conditions, despite limited evidence of efficacy and the paucity of high quality clinical studies. Cochrane reviews do suggest moderate levels of evidence of benefit in fibromyalgia and neck pain. Complications from acupuncture are not widely known. A Health and Disability Commissioner case report in 2008 found informed consent regarding the possibility of organ damage with acupuncture was inadequate. As of July 2016, the website of Acupuncture NZ only describes minor bruising as a complication. A 30-year Chinese review of 115 published articles described a number of serious complications, including 201 cases of pneumothorax. Two prior cases of pneumothorax following acupuncture have been reported in New Zealand, though the true incidence is likely to be under reported. Conclusion: We hope to raise awareness of this rare but potentially life threatening complication of acupuncture. Patients undergoing alternative medical treatments have the same right to informed consent as they do in any other healthcare setting.