Bilateral Tension Pneumothorax Related to Acupuncture

Tagami, Rumi; Moriya, Takuya; Kinoshita, Kosaku; Tanjoh, Katsuhisa

doi:10.1136/acupmed-2012-010284

Cited by 19 publications

(6 citation statements)

References 13 publications

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“…Cases concerning acupuncture-related pneumothorax have been reported. [ 1 , 2 , 5 – 7 , 12 – 14 ] The majority of the reported victims suffered from unilateral pneumothorax; however, there were also reports of bilateral pneumothorax; [ 12 – 14 ] the pneumothorax was related to needle insertion in the upper back or paraspinal area, similar to that in the present case. In these cases, the time interval between the acupuncture treatment and the appearance of symptoms of pneumothorax ranged from less than an hour, to 2 days.…”

Section: Discussionsupporting

confidence: 71%

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

et al. 2018

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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.

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Section: Discussionsupporting

confidence: 71%

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

et al. 2018

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“…As the popularity of acupuncture increases, the importance of determining the safe depths of acupoints also increases, particularly the safe depths in the upper back. Acupuncture on the upper back may cause pleural and lung injuries [ 18 , 19 ]. In pediatric groups, safe needling depths vary largely because of rapid changes in body size and shape.…”

Section: Discussionmentioning

confidence: 99%

Safe needling depths of upper back acupoints in children: a retrospective study

Peng

Huang

et al. 2016

BMC Complement Altern Med

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BackgroundAcupuncture is applied for treating numerous conditions in children, but few studies have examined the safe needling depth of acupoints in the pediatric population. In this study, we investigated the depths to which acupuncture needles can be inserted safely in the upper back acupoints of children and the variations in safe depth according to sex, age, weight, and body mass index (BMI).MethodsWe retrospectively studied computed tomography (CT) images of patients aged 4 to 18 years who underwent chest CT at China Medical University Hospital between December 2004 and May 2013. The safe depths of 23 upper back acupoints in the Governor Vessel (GV), Bladder Meridian (BL), Small Intestine Meridian (SI), Gallbladder Meridian (GB) and Spleen Meridian (SP) were measured directly from the CT images. The relationships between the safe depths of these acupoints and sex, age, body weight, and BMI were analyzed.ResultsThe results indicated significant differences in safe needling depth between boys and girls in most upper back acupoints, except at BL42, BL44, BL45, BL46, GB21 and SP21. Safe depths differed significantly depending on age (p < 0.001), weight (p ≤ 0.01), and BMI (p < 0.05). Multiple regression analysis revealed that weight was the most crucial factor in determining the safe depth.ConclusionsSex, age, weight, and BMI are relevant factors in determining the safe needling depths of upper back acupoints in children. Physicians should pay attention to wide variations in needle depth when performing acupuncture.

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“…Several cases of acupuncture-related pneumothoraces with or without tension pneumothorax have previously been reported. [6][7][8][9][10][11] However, there have not been any reports of haemopneumothorax resulting from acupuncture.…”

Section: Discussionmentioning

confidence: 99%