LAUSR

the left supraclavicular region, lacerating an aberrant vessel at the apex of the lung. Karavis et al. explain that a traumatic haemothorax in the setting of acupuncture can develop as a result of rupture of small contractile vessels, vascular bulla or apical lung parenchyma or an aberrant thin-walled vessel. The case detailed by Tan and Asmat was thought to be due to a vascularized left apical adhesion, torn during acupuncture. Karavis et al. postulate a number of factors that pose a higher risk of acupuncture complications. Our patient had a thin chest wall and is a heavy long-time smoker. Furthermore, Karavis et al. emphasize that techniques such as deep intramuscular stimulation and dry needling techniques in the thoracic region and regions of the shoulder pose a high risk of complications. Although a low complication rate is reported by acupuncture use, the morbidity of a complication is high. Acupuncture is increasingly becoming a practice seen in rural locales as Wardle et al. in their study demonstrated: of 585 general practitioners, more than two-thirds made a referral to an acupuncturist. With increasing use of acupuncture, the potential for more complications rises. As with any invasive procedure to the thorax, for example central line insertion, chest X-ray post procedure is invaluable for the detection of complications. A similar consideration should be granted for patients undergoing acupuncture to the thorax as well. Given the limited resources and facilities available to rural institutions, often these locales are not equipped to deal with the consequences of such complications, and will require tertiary centre assistance, as was the situation in our case. Education of rural acupuncturists regarding the potential complications of acupuncture and the anatomy of high-risk regions is a must in order to ensure patient safety.