Authors: Reindorf R, et al.
Cureus 17(10): e95679 DOI: 10.7759/cureus.95679
A 38-year-old man developed right apical pneumothorax hours after outpatient trigger point injections (TPIs). Chest X-ray/CT showed a retained metallic needle fragment lodged in the parietal pleura. He underwent VATS with successful extraction and was discharged the same day without complications. Documentation from the clinic lacked needle gauge/length and whether ultrasound guidance was used. The case underscores preventable pitfalls in TPIs: inappropriate needle length for cervicothoracic targets, absence of imaging guidance in high-risk locations, and failure to inspect and account for instruments post-procedure. Patient factors (COPD, smoking, environmental exposures) likely amplified pneumothorax risk. The authors advocate standardized needle selection by depth/anatomy, routine post-procedure instrument checks, thorough documentation, and consideration of ultrasound to reduce pleural puncture and needle retention.
What You Should Know
• Pneumothorax after TPIs, though rare, can be catastrophic—risk rises with cervicothoracic targets and longer needles.
• Always match needle gauge/length to depth and patient habitus; use the shortest needle that reliably reaches the trigger point.
• Ultrasound guidance is advisable for high-risk regions to visualize pleura and needle tip.
• Count/inspect needles and hubs before and after injections; document needle specs and whether imaging was used.
• Red flags post-TPI (pleuritic pain, dyspnea) warrant immediate imaging; retained fragments require surgical retrieval when intrathoracic.
• Build clinic protocols: standardized needle selection tables, ultrasound availability, and discharge/return precautions.
Thank you to Cureus for allowing us to review this article.