Autopsy diagnosis of acupuncture-induced bilateral tension pneumothorax using whole-body postmortem computed tomography

Abstract

Rationale:Acupuncture, a component of traditional Chinese medicine, is also a well-known form of complementary and alternative medicine. Serious adverse events of acupuncture have been reported, including the acupuncture-related pneumothorax which is a rare but fatal condition sometimes. The pneumothorax was related to needle insertion in the upper back or paraspinal area and the reported victims suffered from either unilateral or bilateral pneumothorax. Postmortem computed tomography has advantages in the detection of pathologic gas and is being considered as a useful visualization tool for diagnosing the cause of death.Patient concerns:A 52-year-old man underwent acupuncture and cupping treatment at an illegal Chinese medicine clinic for neck and back discomfort and was admitted to the hospital with severe gasp and dyspnea about 30 hours later. The patient suddenly became unconscious with heart rate and blood pressure lost and died after cardiopulmonary resuscitation. Diagnosis, interventions and outcomes: Whole-body postmortem computed tomography of the victim revealed collapse of the both lungs and mediastinal compression, which was also confirmed by autopsy. More than 20 pinprick injuries were found on the skin of the upper and lower back in which multiple pinpricks were located on the body surface projection of the lungs. The cause of death was concluded as acute respiratory and circulatory failure due to acupuncture-induced bilateral tension pneumothorax.Lessons:Acupuncture-induced tension pneumothorax is rare and should be recognized by forensic pathologists. Postmortem computed tomography can be used to detect and accurately evaluate the severity of pneumothorax before autopsy and can play a supporting role in determining the cause of death.

Fatal bilateral pneumothoraces after electroacupuncture treatment: A case report and literature review

“…It is generally considered unlikely that a single lung perforation with a fine needle will cause rapid respiratory failure in a healthy population. However, previous reports have suggested that multiple bilateral lung punctures can lead to fatal bilateral tension pneumothoraces, even in the absence of a significant pulmonary disease background (15–18). As in this case, lung diseases, such as emphysema, are risk factors for the development of pneumothorax after acupuncture (11,14,16).…”

“…To the best of our knowledge, this is the first report of a three‐dimensional reconstruction image of PMCT depicting the distribution of gold thread acupuncture throughout the body. PMCT has an advantage over conventional autopsy in that it is better at depicting gas collections in the body and metallic substances, such as implanted medical artifacts; thus, it is widely used as a routine procedure before autopsy in many institutes (18,30–32). This case demonstrates the usefulness of PMCT and presents an unusual PMCT image finding that requires attention in assessing its relevance to the cause of death.…”

Analysis of cases of traumatic pneumothorax – conclusions based on post-mortem CT examinations for routine autopsy diagnostics

“…Traumatic pneumothorax has not been regarded to date as a topic of special interest or a subject of more in-depth research in the field of forensic medicine. The basic aspects of the problem have been discussed in academic textbooks, and casuistic reports from the field of post-mortem research have appeared in a limited number of publications [2,8].…”

“…Tabela II. Zestawienie procentowego udziału poszczególnych obrażeń i zespołów obrażeń klatki piersiowej w grupie przypadków ze stwierdzoną odmą opłucnową (n = 195) omawiana w podręcznikach akademickich, a nieliczne publikacje prezentowały kazuistyczne doniesienia z praktyki badań pośmiertnych [2,8]. Znacznie więcej opracowań można znaleźć w obszarze nauk klinicznych, w szczególności medycyny ratunkowej i traumatologii [9][10][11][12][13][14][15][16][17].…”

“…Ever since the 1970s, when computed tomography (CT) was first introduced into the medical field, its importance in clinical diagnostics and post-mortem examinations has been steadily growing [1]. Post-mortem computed tomography (PMCT) is useful in the diagnosis of pneumothorax, and in ascertaining the cause of death [2].…”