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.

Keywords: ACUPUNCTURE; MEDICAL EDUCATION & TRAINING; MYOFASCIAL PAIN.

Figure 1

(A) Pain diagram showing the referred pain area over the cervical and interscapular region. (B) Admission X-ray showing pneumo-haemothorax in the right chest (arrows indicate fluid collection). (C) Ultrasound image demonstrating the pleural effusion and the collapsed right lung. The collection fluid is located between the base of the lung and the diaphragm over the liver (arrows). (D) Chest tube inserted at the right base.

Figure 2

The importance of the depth and angle during acupuncture treatment. (A) The acupuncture point ST13 is located in a high-risk body region. Needles (a) and (b) are placed in the correct direction and depth; needles (d) and (c) could damage the large vessels or right pleura. In the same region, acupuncture points ST12, LU1 and LU2 are also in a high-risk anatomical region. (B) Cross-sectional anatomy images provide valuable information, indicating the safe depth, direction and angle of needle insertion in order to prevent inappropriate needle technique.