Holes in the lung (even tiny pin-sized holes) from either spontaneous or procedure-related problems can require the presence of drainage tubes in the chest for prolonged period of time and result in infections within the chest cavity (empyema) with serious consequences. The treatment options available for this type of problem are quite limited. Most holes in the lung tissue will heal spontaneously but in certain situations this is unlikey to occur, particularly if the lung is thin (ie., with emphysema) or if the outer surface of the lung does not come into contact with another surface, (ie., the lung is too small for the chest cavity because of surgical removal of part of the lung or the cannot expand enough because of inflammation, infections, or other disease processes). In these cases the following options exist:

1. Waiting: up to 50% of lung holes can heal spontaneously in time (between days to months) with simple placement of a drainage tube.

2. Surgery: Surgery to help expand the lung, cover the leaking area with a variety of biologic "glues,"  and/or place material (the pleural lining, muscle, pericardium or heart sac, or other) against the area of leakage can sometimes help or seal lung holes but this appoach has the side effect of the need for a surgical procedure and is not a guarantee of success.

3. Intrabronchial one-way valves (IBV): tiny one-way valves can be placed into the airway which leads to the area of leakage by a bronchoscope through the mouth. This places a small valve which appears similar to an umbrella into the tiny "segmental" airways after testing to see if closing that airway will improve or stop the air from leaking (this is done with a tiny balloon catheter). More than one valve may be placed to increase the control of air leakage. These valves are left in place but can be removed at a later date with a second bronchoscopy procedure after the lung has had a chance to heal. This is a new procedure and has only been recently approved by the FDA. Literature regarding these valves in included below.