Presentation
The onset of acute chest pain after a cervical spine physiotherapy session.
Patient Data
There is a paucity of lung markings within the extreme lung apices bilaterally. The left apical pneumothorax is easier to identify due to the visceral pleural edge at the superior margin of the 4th posterior rib costovertebral junction. The chest X-ray is otherwise normal.
The follow-up, portable, seated study performed 1 day later confirms mild progression of the right apical pneumothorax and minimally improved left apical pneumothorax.
Bilateral pneumothoraces are present. The pneumothoraces are small to moderate-sized. No mediastinal shift, no pneumomediastinum, no pneumopericardium and no associated hemothorax is present.
The lung fields are essentially clear. There is no bullous lung disease identified. There are no pulmonary nodules or masses, no ground glass pulmonary infiltrates or areas of pulmonary consolidation. There are no CT significant or suspicious lymph nodes.
The cardiomediastinum is normally opacified.
Improved pneumothoraces bilaterally with the visceral pleural edge at the superior margins of the clavicles at the sternoclavicular articulations.
Case Discussion
The patient confirmed prior attendance to physiotherapy for ongoing cervical pain earlier on the day of the casualty presentation. There is an onset of acute chest pain post her physiotherapy session during which dry needling was performed. This case demonstrates a bilateral iatrogenic pneumothorax due to deep punctures during dry needling and attempted intramuscular stimulation.
The pneumothoraces were treated conservatively and the patient was discharged a few days later.