Bilateral pneumothorax after liposuction: a rare complication

Pneumothorax is a rare complication of liposuction, usually unilateral and following suctioning over the thoracic wall; bilateral pneumothorax and upper-limb involvement are distinctly unusual. A 42-year-old healthy woman presented 11 h after liposuction of the bilateral upper limbs and upper back with dyspnea, left-sided pleuritic chest pain, and upper-body swelling. She was tachycardic and in respiratory distress. Chest radiography showed bilateral pneumothorax with extensive soft-tissue emphysema, and computed tomography confirmed bilateral hydropneumothorax while excluding pulmonary embolism. Bilateral tube thoracostomy achieved lung re-expansion. Hemoglobin fell from 7.4 to 5.9 g/dL despite minimal chest-tube drainage, consistent with occult soft-tissue bleeding, and was corrected by transfusion. She recovered fully. Pneumothorax should be considered in any patient with respiratory symptoms after liposuction, even when the abdomen and flanks are untreated; a normal oxygen saturation on supplemental oxygen should not delay imaging, and vigilance for occult hemorrhage is warranted.