Needlefish are characterized with their rigid, elongated jaws. They are frequently attracted by light at night and may inflict a wound by plunging their sharp beaks into anyone in their path. Therefore, the penetrating injury should be managed as a stab injury, and treatment is determined primarily by the location of the injury. We report on an unusual case of penetrating tracheal injury caused by a needlefish. This diving lobsterman was struck by a needlefish on his anterior neck and presented with extensive subcutaneous crepitus and hemoptysis on arrival at the emergency room. We successfully treated the patient with selective nonoperative management after a thorough physical examination and ancillary evaluation.