A 37 year old female who presented with a history of foreign body ingestion ten months previously was found on examination to have a retropharyngeal swelling. An initial differential of foreign body granuloma or retropharyngeal tuberculous abscess was considered. The usefulness of the lateral neck radiograph in demonstrating retropharyngeal pathology and the supplementary role of the computed tomography scan in confirming and elucidating the identity of the radio-opacity is highlighted. This presentation is a timely reminder of the need for a simple inexpensive lateral neck radiograph in situations of doubt as to persisting foreign body impaction.