Aim: We present a case of bullet fragments migrating into the endotracheal space and discuss the assessment of patients with retained bullets. Background: Many patients who have sustained a gunshot wound (GSW) have retained bullets. Bullets that are not encountered during operative management are rarely removed because of the secondary injuries and complications that removal can cause. Bullets rarely migrate, and thus, the secondary complications from migration are not often considered when patients later present with complications. Case description: A patient initially presented with multiple GSWs and had several retained bullets and bullet fragments in the mediastinum. Over the next 3 years, he presented numerous times with hemoptysis, cough, and chest pain but no clear etiology. Eventually, it was recognized that a collection of bullet fragments had eroded through the tracheal wall. Conclusion: Migration of bullets and/or bullet fragments into the bronchi or trachea should be considered in patients who have a history of GSW to the mediastinum and present with hemoptysis or pneumonia. Clinical significance: This patient presentation shows that bullet migration can occur at any time after injury, and delays in considering the diagnosis and initiating the appropriate workup can result in a delay in diagnosis.