Acupuncture-Induced Haemothorax: A Rare Iatrogenic Complication of Acupuncture

Abstract

This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800 mL of bloody fluid (haematocrit (Hct) 17.8%) in 24 h and 1200 mL over the following 3 days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3 g/dL. The patient recovered completely and was discharged after 9 days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48 h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques.

Pneumothorax after acupuncture

“…The lung surface is about 10–20 mm beneath the skin in the region of the medial scapular or midclavicular line. Acupuncturists must know the anatomical structures and layers that are located beneath all the acupuncture points, especially for high-risk acupuncture points 16…”

Bilateral Pneumothorax Following an Acupuncture

“…In the paper, five mortalities were reported. There was even a case report of hemothorax following an acupuncture session (Karavis et al 2015). In another systematic review, common adverse effects of acupuncture in China from 1980 to 2013 were pneumothorax, central nervous system injury and solid organ injury (Wu et al 2015).…”

A Rare Complication Caused by Dry Needling Method: Tension Pneumothorax

“…(2) Iatrogenic pneumothorax is more frequent when dry needling is applied to the upper trapezius, thoracic erector spinae, and rhomboid muscles. Other regions in the chest area with pneumothorax risk are the subclavicular region, supraclavicular region, intercostal spaces, interspinal spaces and congenital foramen associated with the sternum, and the suprascapular and infrascapular fossa (3,8). In 1 of the reported cases, needling was applied to the paravertebral point in the spinous process of the third vertebra, and in the other, between the spinous process and the scapula (4,5).…”

“…(1) Several adverse effects associated specifically with dry needling have been reported. These include soreness after needling, local hemorrhage at the needling site, asyncopal responses, and pneumothorax (1)(2)(3)(4)(5). Pneumothorax is a well-recognized but rare adverse event related to acupuncture or deep dry needling over the thorax.…”