Tehran University of Medical Sciences Case Reports in Clinical Practice 2538-2683 7 5 2023 02 12 242 245 EN Hamid Asadzadeh Aghdaei Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Amir Sadeghi Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Gholamreza Nouri Assistant Professor of Gastroenterology and Hepatology, School of Medicine, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical Sciences, Ilam, Iran. Naghmeh Salarieh Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Pardis Ketabi Moghadam Assistant Professor of Gastroenterology and Hepatology, School of Medicine, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical Sciences, Ilam, Iran. 2022 04 05 2022 07 27 Esophageal-pleural (E-P) fistula is introduced to be an uncommon clinical finding maybe due to non-specific clinical pointers and vague radiologic clues. In this regard, the main drivers are esophageal traumatization, endoscopic dilation, irradiation and corrosive agent ingestion as well as major underlying esophageal diseases like carcinomas and tuberculosis. The presented case is a 51-year-old man with medical record of recurrent pneumonias resulted in right lobectomy who admitted to the medical institution with a significant empyema leading to chest tube insertion. It should be noted that the presence of food particles in the chest bottle in addition to the history of previous surgery raised suspicion of a post-surgical E-P fistula formation. Attempts were made to find fistula tract and insert an esophageal stent bypassing the fistula opening. However, investigations argued against E-P fistula as an ensuing event after surgery and arose the question that whether E-P fistula would be the cause or effect of pneumonia in the presented case? https://crcp.tums.ac.ir/index.php/crcp/article/view/670