Case History and Description:
A 28-year-old female presented with complaints of severe right-sided chest pain following acupuncture in which needles were inserted into the chest wall. The pain began spontaneously and was pleuritic, with an intensity rating of 8 out of 10. When the patient began to experience shortness of breath, she went to the emergency room (ER). The right-sided chest pain began 30 minutes before the ER visit and radiated to her shoulder. Deep breaths, movement, and coughing aggravated the pain. In addition, the patient had a history of anxiety and depression. The patient did not smoke. She was taking sertraline for depression. She was afebrile, blood pressure was 126/82 mmHg, heart rate was 88 beats per minute, and her oxygen saturation was 94% on room air. The patient was started on nasal cannula oxygen therapy. The first chest x-ray revealed a pneumothorax with no shifting. Due to worsening shortness of breath, a follow-up x-ray revealed a right-sided pneumothorax in the apical region, 40.5% measuring 38 mm, with a mediastinal shift to the left which was concerning for the development of tension pneumothorax (Figure 1). As a result, a chest tube was immediately inserted. The patient’s pain was managed on an as-needed basis. Hemoglobin was 11.5 g/dL, WBC was 6.2 K/uL, and platelets were 146 K/uL. The sodium concentration was 142 mmol/L, the potassium concentration was 4.0 mmol/L, the chloride concentration was 110 mmol/L, and the calcium concentration was 8.4 mg/dL. After remaining persistent for two days, the pneumothorax shrunk to 20mm. The chest tube was removed, and the patient appeared comfortable on room air. She was finally discharged home with instructions to resume home medications.