CASE PRESENTATION: A 51-year-old woman with a history of lung adenocarcinoma, T4N3M1, presented with nausea and vomiting with oral intake. She also reported fever, dyspnea, and right-sided chest pain. Patient was undergoing CRT with weekly carboplatin and paclitaxel. At the time of presentation, she had received 9 cycles of chemotherapy and 52 Gy of IMRT targeting her mediastinal mass. Physical exam was remarkable for tachycardia, tachypnea and diffuse rales. CT thorax showed a thick-walled air collection posterior to the right mainstem bronchus (RMB) with marked consolidation of the right lung. Patient was treated with antibiotics and underwent fiberoptic bronchoscopy that revealed necrotic RMB with absent posterior wall and no definable distal anatomy. Subsequent esophagogastroduodenoscopy showed an esophageal perforation with direct communication into the mediastinum and RMB. Anatomy was not amenable to stenting and patient subsequently expired after family decided to pursue comfort measures.