Scapulothoracic arthroscopy is gaining recognition among arthroscopic procedures as it is considered a relatively low morbidity procedure; also, continuing studies of this technique are making it safer. Scapulothoracic arthroscopy can be used for removal of a foreign body. This case report describes the removal of a firearm projectile using image-guided arthroscopy, highlighting the anatomical aspects and characteristics of the surgical technique. In this case, the patient recovered uneventfully, with complete remission of symptoms in 30 days, returning to his usual activities within 2 months after surgery.