Sequential Bilateral Pneumothorax Following Acupuncture Presenting as Left Tension Pneumothorax: A Case Report

Acupuncture is commonly used for musculoskeletal pain and is generally regarded as safe; however, pneumothorax remains one of its most important mechanical complications, particularly when needling is performed over thoracic and upper-back sites. We report the case of a 30-year-old man who developed immediate pleuritic chest pain, chest tightness, and dyspnoea after acupuncture to the upper back, bilateral trapezius muscles, and infrascapular regions. He delayed presentation until the following morning, when symptoms worsened. Examination demonstrated tachypnoea, reduced left-sided air entry, and hyperresonance. Chest radiography showed a large left tension pneumothorax with near-complete collapse of the left lung. A 20 Fr Seldinger chest drain was inserted under local anaesthesia with prompt improvement. Repeat imaging showed partial left re-expansion and a small right-sided pneumothorax. Digital monitoring with Thopaz (Medela AG, Baar, Switzerland) confirmed cessation of the air leak, and computed tomography (CT) of the thorax demonstrated complete left-sided resolution, a small residual right pneumothorax, and no structural lung abnormality. This case highlights delayed presentation despite immediate symptom onset, the possibility of bilateral pleural injury after bilateral thoracic needling, and the importance of repeat imaging when the initial pathology appears unilateral.