CASE PRESENTATION: A 66-year-old man with a prior 15-pack-year smoking history presented with worsening cough productive of white sputum and dyspnea upon awaking and with moderate exertion. Two months earlier, video assisted thoracoscopic surgery and right upper lobe wedge resection with blebectomy were performed after secondary spontaneous pneumothorax occurred in the setting of significant centrilobular and paraseptal emphysema. He returned with a multiloculated pneumothorax requiring computed tomography guided chest tube insertion and drainage. Flexible bronchoscopy under intubation revealed an accessory right tracheal bronchus two centimeters above the carina. A #7 Fogarty catheter with a balloon was used to serially occlude the accessory tracheal, right mainstem, right upper, right middle, right lower lobe and superior segmental bronchi without complete resolution of the air leak, suggesting the presence of a bronchopleural fistula with either multiple contributing or distal interconnecting airway sources, a common problem in emphysema. The decision was made to pursue EBV placement since decreasing axial airflow to the bronchopleural fistula can lead to subsequent closure. Deployment of two #7 intrabronchial valves (IBVs, Spiration, Redmond, WA) to the tracheal bronchus and the apical segment of the right upper lobe lessened the leak. By the time of discharge, four days after chest tube removal, chest x-ray demonstrated interval lung volume expansion. The patient had improved respiratory tolerance, exhibiting exertional dyspnea only after climbing one flight of stairs. After three months, he resumed his hobby of swimming, and spirometry showed no signs of obstruction.