A 64-year-old male smoker who was previously healthy underwent intracranial aneurysm clipping after subarachnoid hemorrhage. Thoracic computerized tomography which was taken a day before the surgery revealed small bullae and low attenuation area in bilateral lower lobes. Soon after the completion of the surgery, the patient began to breathe, and then developed cough, 5 min later oxygen saturation decreased, and diminished breath sounds were detected in the left lung. Tube thoracostomy was performed and eventually resolved the complication. Bilateral pneumothorax, pneumomediastinum, and subcutaneous emphysema were confirmed by computerized tomography later. Early recognition and intervention of perioperative pneumothorax and pneumomediastinum can improve the patient's outcome.