A doctor who specialises in chest medicine was left with a bilateral pneumothorax, after needles used during acupuncture for stiff shoulders penetrated her pleura, Japanese doctors report.

The doctor had a low BMI of 16.9 and an ultrasound later revealed the distance between the epidermis and pleura at the attachment of the suprascapular angle of the levator scapulae muscle was just 22mm, say doctors from the Keio University School of Medicine in Shinjuku-ku, Tokyo.

But, acting in haste to quickly relieve the 31-year-old doctor’s severe muscle stiffness in her neck and shoulder, the experienced acupuncturist opted for 60mm long needles, the largest available and designed for the lumbar or buttock region.

When inserted into the scapular levator muscles to a depth of 20-30mm, the needles penetrated the pleura bilaterally, her treating doctors wrote in BMJ Case Reports.