Thoracic complications from "lost" gallstones following laparoscopic cholecystectomy include empyema, hemoptysis, and cholelithoptysis. These rare complications sometimes require surgery but not all presentations of thoracic gallstones mandate operative intervention. Because of these potential complications of "lost" gallstones, reasonable efforts should be made to retrieve gallstones spilled during cholecystectomy. Persistent pulmonary symptoms following laparoscopic cholecystectomy mandate further radiologic examination and a review of the patient's operative report for "lost" gallstones.