The case presented describes the migration of a surgical swab across the left hemidiaphragm over four years. The patient had at least two episodes of haemoptysis in that period and was misdiagnosed and treated for Pulmonary Tuberculosis. When the proper diagnosis was made and a lobectomy was planned for removal of the swab, the act of anaesthesia revealed a major bronchoabdominal fistula that was resolved by simply isolating that lung with an endobronchial tube. According to our search, such a left-sided broncho-abdominal fistula has, to date, not been described in the literature.