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.