Foreign body aspiration (FBA) usually occurs in children and the elderly. We report a 69-year-old man who had left-side massive pleural effusion and empyema secondary to a movable foreign body, without knowing the exact time of the FBA. A suction tube, 11 cm in length, was initially found by chest radiography and computed tomography (CT) in the lower trachea extending to the left bronchus. However, 4 days later, the suction tube was retained between the lower trachea and right bronchus, using flexible bronchoscopy, and then removed successfully. Empyema in the left side persisted, so video-assisted thoracoscopic surgery for decortication was performed, and his pneumonia then improved. FBA may be undetected due to an atypical history or misleading clinical and radiological findings. It can be unrecognized for a long time until symptoms and signs occur or persist. FBA is sometimes a life-threatening emergency and requires prompt attention. Flexible fiberoptic bronchoscopy can be chosen as the first-line approach to remove the foreign body.