Inspired by Chai et al 2026.[1]
IF – impact factor
BCE – before common era
ED – emergency department– key to acronyms
This case report comes from Wuhan, China, and reads a bit like an investigative crime novel in places. It was published in the journal Forensic Science, Medicine, and Pathology (IF 1.4), which is a hybrid journal from Springer Nature and was first published in 2005.
The first issue of this journal included an historical review of autopsy that caught my eye.[2] Unfortunately, the timeline jumped from 3000 BCE Egypt and the embalming of the Pharaohs to 500 BCE Greece and the written records of Hippocrates, Aristotle and others. China was not mentioned at all, apart from the sequence of letters appearing once in the word ‘machination’ towards the end of the paper ([autopsy] …is the subject of political machination).
There is a suggestion from the work of Vivien Shaw that dissection was performed in ancient China and likely to be the basis for the nomenclature of acupuncture points and meridian pathways.[3,4] I guess it is unfair to criticize the review by Burton,[2] since it was published over a decade before Vivien’s first suggestions concerning Han dynasty anatomists.[3]
Fatal bilateral pneumothoraces have come up twice before on this blog (see Fatal bilateral pneumothoraces from 2021 and Another fatality from 2018), although there are a number of such cases in the literature to date (see the post from 2021).
This case concerns a 37-year-old man with lower back pain who attended a massage therapist who was not a licenced acupuncturist, but who proceeded to insert 20 to 30 needles into his back. Some of these needles reached as high as the lower thorax and unfortunately both lungs were needled. Around 15 minutes after the start of the treatment he became breathless and the needles were removed only after a further 5 minutes. After a another 40 minutes, the man’s partner performed acupuncture on the sides of his torso in an attempt to relieve his discomfort. An hour and a half later his dyspnoea worsened and, some 10 minutes later, on reaching hospital, he was in cardiopulmonary arrest. Some resuscitation appears to have been attempted, with an audible ‘gush of air’ noted on needle thoracostomy in ED.
Autopsy revealed injuries to both the liver and the spleen as well as both lungs. There was 100mls of bloodstained fluid in both pleural cavities and 300mls in the abdominal cavity.
As a result of the meticulous examination of the needle tracks in the organs and the position of haematomas and lung damage, the pathology team suspected that two different people were involved in the ‘treatment’. This led to further inquiries and revealed the full story as detailed above.
We are all well aware of the risk of pneumothorax, so reporting this case is not going to change our practice; however, the unnecessary death of a healthy 37-year-old man is a stark reminder of the potential risks of penetrating the body with needles, even the very fine needles used in acupuncture.
In recent years I have heard of 2 cases of bilateral pneumothorax following acupuncture in the UK, but neither have been reported to my knowledge, despite my insistence of the importance of reporting such events. Both reports came from physicians working in acute medicine and thankfully the patients both survived. Unless will report such serious, potentially life-threatening events, there will be little interest in improving standards of training and regulation in the sector.
References
1 Chai Q, Huang J, Yin S, et al. Accidental death due to acupuncture-induced multiple organ injuries: fatal improper practices. Forensic Sci Med Pathol. Published Online First: 26 January 2026. doi: 10.1007/s12024-025-01099-0
2 Burton JL. A bite into the history of the autopsy : From ancient roots to modern decay. Forensic Sci Med Pathol. 2005;1:277–84. doi: 10.1385/FSMP:1:4:277
3 Shaw V, Mclennan AK. Was acupuncture developed by Han Dynasty Chinese anatomists? Anat Rec. 2016;299:643–59. doi: 10.1002/ar.23325
4 Shaw V, Diogo R, Winder IC. Hiding in Plain Sight-ancient Chinese anatomy. Anat Rec. 2022;305:1201–14. doi: 10.1002/ar.24503
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