A 57-year-old man with a past medical history of pulmonary tuberculosis and severe COPD was admitted for a spontaneous pneumothorax. Chest CT demonstrated significant RUL bullous disease. The patient underwent video-assisted thoracoscopic surgery, with resection of apical and posterior segments of the RUL. It was felt that the anterior segment was less diseased, and given the severity of baseline compromise and the need for tissue sparing, it was decided that the anterior segment was better not resected. A postoperative leak was present, and on postoperative day 5, IP was consulted; a completion lobectomy was not considered, again due to severity of underlying disease. Bronchoscopy with balloon occlusion was performed in the ICU. Sequential balloon occlusions from the proximal to the distal airways failed to impact the rate of air bubbling through the fluid chamber of the water seal chest drain. Whereas the BPF most likely emanated from the area of resection, the RUL, EBVs were empirically placed in two adjacent segments, the remaining anterior segment of the RUL and the superior segment of the right lower lobe (RLL), with a marked decrease in air leak. The next day, however, there was a marked increase in leak. Bronchoscopy with balloon occlusion was again performed, this time under general anesthesia in the OR. Only minimal reduction of the leak was seen, even with occlusion of the right main bronchus. The chest tube was clamped at its exit from the chest wall, with complete cessation of bubbles in the water chamber. This maneuver demonstrated that there was no defect in the chest tube apparatus external to the thorax. Given the lack of benefit from the previously placed EBVs, they were removed. A CT of the chest was ordered to look for an anatomic explanation for the EBV failure. This showed that the chest tube had migrated into an apical bleb present in the unresected anterior segment of the RUL. Based on these findings, the chest tube was clamped despite the air leak. The postclamp chest X-ray was stable without any evidence of a pneumothorax, and the chest tube was removed 2 days later, with repeat chest roentgenogram showing no pneumothorax. The patient was subsequently discharged in stable condition.