Intrapulmonary aberrant needles are rarely encountered in clinical practice. An intrathoracic aberrant needle should be always surgically removed as soon as possible. We report a case of an intrapulmonary aberrant needle removed with video-assisted thorascopic surgery (VATS) and briefly review the literature. A 47-year-old man referred to us for chest discomfort was found to have an intrapulmonary aberrant needle at the right middle lobe by chest X-ray and computed tomography (CT). We tried simple extraction under thoracoscopy, but a residual fragment was recognized by intraoperative X-ray after the removal of the needle from the surface of the lung. We searched for the residual fragment by real-time fluoroscopic examination. Partial resection was performed to remove the residual needle fragment at the right lower lobe. The postoperative course was uneventful and the man was discharged on the postoperative day 10. Intraoperative chest X-ray is always necessary before closing the chest to avoid leaving the residual fragments in the lung. The real-time fluoroscopy is useful to search for the residual fragment.