RE: Hemopericardium Following Acupuncture?

• The authors have no financial conflicts of interest. which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1 reported a case of hemopericardium following acupuncture by an unauthorized acupuncturist. This report documents the case of a female patient who had a thoracostomy and was transferred to the emergency department of the au-thors' hospital. The patient's hemopericardium was discovered by CT after thora-costomy. The authors reached the diagnosis of " traumatic hemopericardium with right-sided pneumothorax related to acupuncture " because of the patient's experience with acupuncture before thoracostomy and the radiological findings after tho-racostomy. To improve the quality of case reports regarding the possible dangers of acupuncture , we suggest additional comments from the perspective of acupuncture experts. First, information on the depth and direction of needle insertion in the tho-racic region seems crucial to assessing the causal relationship of acupuncture for hemopericardium in this case, if available. Several traditional and modern studies have warned against inserting needles perpendicularly in acupuncture points of the thoracic region and have urged only superficial or oblique needle insertion in order to avoid fatal organ penetration. 2,3 However, this report does not provide any clues to identify whether needle direction or depth is sufficient to have caused hemopericardium. Given that the presented event might be due to nonadherence to safety guidelines and improper use of acupuncture by an unauthorized acupuncturist lacking professional medical training, this information is crucial. In future case reports relevant to acupuncture, we suggest referring to relevant items in the Consolidated Standards of Reporting Trials (CONSORT) Extension for details about acupuncture needling whenever this information is available. 4 Second, further evaluation through CT scan and description regarding whether any anatomical deformity (i.e., sternal foramen) was found is necessary to investigate the possibility of unexpected needle penetration, as reported in a previous case report by Kirchgatterer, et al. 5 In 10% of men and 4% of women, the sternal fora-men can be located on the CV 17 acupuncture point, 3 one of the needled points in this case. As previous case reports have shown that anatomical deformities can lead to cardiac tamponade after acupuncture, 6 the authors should have thoroughly investigated and reported whether a sternal foramen contributed in this case. Finally, the authors appeared to confuse acupuncture point CV 13 or CV 14 with ST14 (when referring to the lower 3 cm …