Recurrent pneumonias in children may be from an unrecognized aspirated foreign body. Our patient was a 10-year-old neurologically impaired child with an aspirated tooth in the right lower lobe segmental bronchus that was inaccessible to extraction using flexible bronchoscopy because of its extremely distal location. We used intraoperative ultrasound during thoracoscopy to locate the foreign body, a tooth, and to facilitate a wedge resection of the involved lung. This combined approach with ultrasound and thoracoscopy can be useful in managing an aspirated foreign body that cannot be extracted from the airway using conventional rigid or flexible bronchoscopy.