Destroyed lung is described as a nonfunctional lung and is most often caused by inflammatory diseases [
4]. It is an unusual condition if it is due to foreign body aspiration. Foreign body aspiration occurs frequently in children because of their habit of placing objects in the mouth [
5]. The consequences of their presence in the respiratory tract due to the delay in management are devastating, with very serious long-term respiratory disorders. According to the literature, an early extraction time limited to the first 72 hours after choking syndrome is an important condition for an uncomplicated outcome [
3]. In our case, the foreign body was detected after 4 years. A systematic literature review reported that the duration of foreign body retention ranges from 18.4 to 25.8 months [
6]. A long-standing foreign body in the bronchial tree results in irritation and inflammation and provokes the development of granulation tissue that causes obstruction. Any delayed obstruction of the bronchus and atelectasis can destroy the architecture of the lung and produce bronchiectasis and related complications such as hemoptysis, empyema, and recurrent pneumonia as presented in our observation [
2]
5‐
8. If risk factors of unknown diagnosis such as alcohol use, drug abuse, senility, seizures, general anesthesia, trauma, mental retardation, and inhaled dentures are found in adults [
5], we think that, in the Malagasy context with a strict formal education, we learned through observation that risk factors are due to the child’s inability to disclose a history of penetration syndrome because they fear their parents’ reactions. Early diagnosis of FBA is easy when the medical history of aspiration is evident or when the patients manifest definitive symptoms, such as choking [
2]. As in our case, if the medical history is unclear and not conclusive, all attempts to confirm or to exclude the diagnosis must be made. On chest X-ray, not all intrabronchial foreign bodies are radiopaque [
6]. The most common findings are radiological signs related to complications such as the destruction of the pulmonary parenchyma, atelectasis, hyperinflation, and bronchiectasis [
2,
5,
6,
8‐
10]. Pulmonary destruction is often unilateral and localized and mainly affects the right lung owing to the anatomy of the right bronchus, which is approximately vertical [
7]. In our case, the foreign body was localized in the left lung. In a study conducted by Nasim Tahir
et al., the variability in the position of the carina with respect to the mid-trachea may explain why this right-sided preference is less pronounced in children compared with adults [
11]. In delayed diagnosis, the bronchial wall in contact with the foreign body was hypertrophic with strong inflammation (granuloma formation, dense adhesion). In cases with delayed diagnosis (> 3 days), the incidence of granulomatous hyperplasia increases to 83.1% [
12]. For these considerations, a standardized assessment of invasive bronchoscopy should be used to reduce unnecessary endoscopic procedures if extraction should be impractical. Some authors have reported on the success of belated removal of foreign body after the instillation of fibroblast inhibitory molecules [
3]. The use of this technique may be justified if there are no arguments for bronchopulmonary complications, and especially if the delay in diagnosis is not significant. It was not the case in our observation because our center is neither equipped with pediatric fiberoptic bronchoscopy nor these molecules used, and our child presented with a destroyed left lung that was nonfunctional on CT scan. Surgical interventions are required in cases wherein bronchoscopic extraction is difficult, with the most frequent surgical strategy being a bronchotomy or a pulmonary resection [
2]. As in literature, a surgical lung resection was required in our observation to address lung complications (the risk of contamination of the contralateral lung and to remove the shunt effects) to improve the patient’s quality of life [
3‐
5]. However, children are at high risk of death, with possible major and minor morbidities following pneumonectomy, and we agree with the many authors in the literature that prudence is advised for this particular population of patients. In their follow-up period of evaluation of 18 cases of pneumonectomy, the authors reported no mortality and three postoperative minor complications. This study included various etiology of destroyed lung and concluded that the morbidity and mortality rates of pneumonectomy are acceptable for selected and well-prepared children [
4]. In another evaluation, a study of pre- and postoperative characteristics of 20 children who underwent pneumonectomy for different etiologies showed that correct selection of indications, intensive preoperative rehabilitation with eradication of infection, careful execution of anesthetic and surgical procedures, early management of complications, and long-term support including pulmonary physiotherapy are essential conditions to decrease morbidity and mortality rates of pneumonectomy in child [
9]. These risk factors for mortality in children following pneumonectomy were evaluated by Verónica Giubergia
et al. in their study with 51 pneumonectomy in childhood, and the authors reported 4% mortality rate at 1 month. They concluded that age ≤ 3 years and the need for ventilation assistance ≥ 4 days were associated with increased risk of morbidity and mortality [
13]. In the case of fatal aspiration of a foreign body, John Isherwood
et al. reported two observations requiring extracorporeal membrane oxygenation (ECMO) support. This technique should be considered for patients with cardiorespiratory instability and who are then skeptical of bronchoscopy or early surgery [
8].