Prolonged air leak (PAL), which refers to air leakage that persists longer than normal after thoracostomy tube drainage, is a common complication in thoracic surgery. PAL can occur in various situations, such as after pulmonary resection or in patients with spontaneous pneumothorax. The etiology of PAL is often related to impaired healing of disrupted alveoli and poor apposition of the lung with the parietal pleura. Risk factors for PAL include male sex, chronic obstructive pulmonary disease, lower FEV1, history of smoking, chronic steroid use, diabetes mellitus, and certain surgical factors like right upper lobectomy and pleural adhesions. Lower diffusing capacity of the lung for carbon monoxide and lower FEV1 are also associated with PAL after lung volume reduction surgery. Air leakage can lead to pneumothorax and delay healing, inhibiting lung expansion. Underweight patients with lower BMI may be at higher risk for PAL due to lower nutritional status and poor wound healing. Scoring systems have been developed to predict the risk of PAL. Overall, PAL management requires careful monitoring and appropriate interventions to promote healing and prevent complications.(AI)