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Summary: We report a case of foreign body induced endobronchial actinomycosis secondary to a shirt button aspirated 30 years previously. Radiological and bronchoscopic appearances mimicked that of lung cancer. However pathology revealed gram-positive anaerobic infection with actinomycosis, which was successfully treated with antibiotics. Previously reported incidences of this rare presentation have been due to organic material, usually food matter. This case illustrates the importance of evaluating episodes of foreign body aspiration and also considering actinomycosis in the differential diagnosis of endobronchial mass. Repeating bronchoscopy after treatment and clinical improvement revealed a reduction in the size of the endoluminal mass and is therefore essential to exclude a foreign body or tumour not seen on initial assessment. [Copyright &y& Elsevier]