Pneumothorax developing secondary to acupuncture is rare. However, in an undiagnosed case, it may cause fatality. The real incidence of acupuncture-related pneumothorax is not known but is acknowledged to be underdiagnosed and under-reported. We describe pneumothorax occurring in a 52-year-old woman who developed bilateral pneumothoraces, with one side being a tension pneumothorax, immediately following acupuncture. The needle was inserted at a paravertebral point at the level of the third vertebral spinous process.