Foreign bodies that penetrate the esophagus and migrate extraluminally are unusual. If they are left untreated, serious complications arise from mediastinitis, and damage to the major structures in the neck can occur. We report a case of a patient who presented with chest pain on inspiration that was found to be caused by a foreign body in the parapharyngeal space and middle mediastinum. Preoperative imaging is critical in obtaining landmarks for safe surgical exploration and is essential to the successful management of penetrating and migrating foreign bodies. This case highlights the importance of localizing the foreign body preoperatively to aid in its surgical removal via a transcervical approach.