Subcutaneous emphysema is a known but rare complication in shoulder arthroscopies. Addition of complications like bilateral hydrothorax confuse the situation to the intensivist. We report the case of a patient posted for shoulder arthroscopy who developed subcutaneous emphysema but later diagnosed to have bilateral hydrothorax. The perplexity in the diagnosis was cleared by investigating further. This case report attempts to resolve the diagnostic confusion involved in managing complications after shoulder arthroscopy.