BACKGROUND: Acupuncture is widely used and generally safe, but pneumothorax is a serious complication of needling in the neck, shoulder, or upper back. Bilateral pneumothorax is rare and can present with nonspecific symptoms, delaying diagnosis. This case report highlights the presentation of immediate cough during upper-back needling, delayed presentation with bilateral pneumothorax despite preserved oxygenation, and radiographic regression during specialist-supervised conservative inpatient management.

CASE REPORT: A 26-year-old woman presented to the emergency department with persistent cough, pleuritic chest pain, and difficulty taking a full breath 2 days after acupuncture in the trapezius region. She was otherwise hemodynamically stable, with a blood pressure of 132/93 mm Hg and oxygen saturation of 100% on room air, but had marked tachycardia (140 beats/min at triage) and decreased right-sided breath sounds. Chest radiography showed bilateral apical pneumothoraces measuring 21 mm on the right and 17 mm on the left. Computed tomography pulmonary angiography excluded pulmonary embolism and confirmed bilateral pneumothoraces up to 23 mm without hemothorax. Preserved blood pressure and oxygenation, absence of respiratory compromise, and availability of specialist inpatient monitoring supported conservative management without pleural intervention. Serial radiographs showed regression to 6 mm on the right and 9 mm on the left before discharge.

CONCLUSIONS: Recent acupuncture involving the neck, shoulder, or upper back should prompt consideration of pneumothorax in patients with chest pain, cough, dyspnea, or unexplained tachycardia, even when oxygen saturation is normal. Conservative inpatient management may be feasible only in carefully selected patients with bilateral procedure-related pneumothorax under close specialist clinical and radiographic surveillance.

Keywords: Acupuncture, Emergency Medical Services, Iatrogenic Disease, Pneumothorax