The authors report the case of a child who had severe bronchial synechia of the left main bronchus after removal of a pistachio shell embedded in granulation tissue. Histology finding of the removed granulation tissue at initial bronchoscopy showed an Actinomyces bacterial invasion. It was decided not to treat this local contamination and to perform a control bronchoscopy to verify the disappearance of local bacterial invasion. The control bonchoscopy performed 4 weeks after the foreign body (FB) removal disclosed a large central left main bronchus synechia producing a 70% reduction of the lumen, although the child had become asymptomatic except for a slight residual cough. The resection of the synechia restored a normal bronchial lumen. The performance of a systematic control bronchoscopy after removal of long standing FB is discussed and recommended.