Adverse reactions associated with acupuncture are common even in standard practice. The incidence of recorded reactions are various from mild symptoms: tiredness, itching, dizziness or nausea to serious symptoms: pneumothorax, cardiac injury or infection. Recently we experienced one patient, a 36-year-old woman, admitted to the emergency department with chest pain, dyspnea and back pain one hour after acupuncture treatment. The diagnosis was a left-sided pneumothorax by chest PA X-ray and chest HR CT. In this study, we differentiate spontaneous pneumothorax from misunderstood iatrogenic. Further evaluation between adverse effects and similar symptoms is needed,