Hemopneumothorax after acupuncture

Abstract

INTRODUCTION: The first written documentation of acupuncture dates back to the 100BC in the Chinese literature Huangdi Neijing, this form of alternative therapy has become increasingly popular globally in the last 20 to 30 years. While viewed by many as an effective means for pain relief, one should also be aware of the possible complications associated with this procedure. CASE PRESENTATION: We present a case of a 45 year old man, with unremarkable past health, who had been a smoker for 20 years. On the day before admission, he went to an acupuncturist for neck pain, who subsequently inserted acupuncture needles over his left supraclavicular region and back. At the time the supraclavicular acupuncture needle was removed, he experienced sudden onset left chest pain and dyspnoea. He then presented to the emergency department where a chest x-ray showed left pneumothorax and left pleural effusion. A chest drain was inserted, and he was admitted to our surgical ward. Over the next 24 hours, the chest drain bottle had accumulated 1 litre of heavily blood stained fluid. The haemoglobin drop over these 24 hours was from 12.8 to 11.4 g/dL. On repeated chest x-ray, there was partial re-expansion of the left lung, with residual rim of apical pneumothorax and apical collection of fluid. At this point, we decided to go into theatre. On left video assisted thoracoscopy (VAT) exploration, there was approximately 400ml of blood clots in left pleural space. A fibrovascular adhesion band over the left upper lobe apex was torn with slow active bleeding from the parietal pleura end of the band. Haemostasis was achieved with diathermy. Mechanical pleurodesis was performed using Prolene mesh abrasion to the parietal pleura. The patient was discharged home on post-operative day 3 with the lung fully expanded on chest x-ray. DISCUSSION: Previous systemic reviews of the adverse events associated with acupuncture concluded that minor adverse events may be considerable but serious events were rare. Pneumothorax was rare, occurring only twice in nearly a quarter of a million treatments. A review in 2004 found reported a total of 715 cases with acupuncture associated adverse events. Within the 715 reports, there were 191 cases of pneumothorax and one case of haemothorax. A systemic review in 2012 of Chinese literature from 1956-2010 found 167 articles with 1038 cases. The most frequent adverse events were syncope (468 cases) and pneumothorax (307 cases). There is one reported case of mortality from acupuncture-induced pneumothorax, the patient died because of bilateral tension pneumothorax. Most of the reported cases of acupuncture-induced pneumothorax do not require surgery, but because of the associated substantial haemothorax in our case, surgery was warranted. CONCLUSIONS: Due to the increasing popularity of alternative therapy, medical practitioners should also be aware of other forms of therapy and their associated complications.