Treatment of pneumothorax following acupuncture: is a closed thoracostomy necessary for a first choice of treatment modality?

BACKGROUND

Acupuncture is currently the most popular of all forms of complementary and alternative medicine, and acupuncture is not dangerous in the hands of a trained practitioner. However, complications of acupuncture including pneumothorax have been reported.

OBJECTIVES

Despite the use of fine needles in acupuncture, the lung-collapsed degree of acupuncture pneumothorax is relatively high. In general, the treatment modality of acupuncture pneumothorax is closed thoracostomy with a chest tube of larger diameter. However, the treatment of acupuncture pneumothorax frequently faces controversy concerning the necessity of a standard chest drain insertion.

DESIGN

This was a retrospective study from March 1994 to February 2004.

SUBJECTS: Nine (9) patients were admitted due to pneumothorax following acupuncture from March 1994 to February 2004 in Hanil General Hospital, KEPCO Medical Foundation (Seoul, Republic of Korea).

RESULTS

Five (5) patients had a moderate degree of pneumothoraces, while 4 patients had a severe degree of pneumothoraces. Four (4) patients were treated by closed thoracostomy with a standard chest drain and the other four patients were treated by the percutaneous chest drainage with a narrow-bore central venous catheter. One (1) patient with a mild degree of pneumothorax was treated only by nasal oxygen inhalation. One (1) patient was treated by video-assisted thoracic surgery after the closed thoracostomy due to continuous air leak.

CONCLUSIONS

We treated the acupuncture pneumothorax by making a choice between the closed thoracostomy and the percutaneous chest drainage based on a smoking history and chest radiographic findings. In the absence of smoking history and pulmonary emphysema or bullae, we got favorable results, not by the closed thoracostomy but only by the percutaneous chest drainage with a narrow-bore central venous catheter.