This is a report of a 56-year-old female patient who was admitted at our institution for the clarification of diffuse interstitial infiltrations of the lower lung lobes and hilar and mediastinal lymphadenopathy. A malignancy, in particular a non-Hodgkin lymphoma, was initially suspected and a mediastinoscopy was primarily performed to gain a sufficient amount of material. A bleeding which occurred during this procedure was handled with local compression with a gauge and minimal use of local electrocautery. The procedure was concluded with sampling of the enlarged lymph nodes at the right inferior paratracheal level without complete resection.
Radiological control on the first postoperative day excluded hematoma formation or pneumomediastinum and the patient was discharged on the next day. The histological examination of the specimens showed a histiocytic lymphadenitis. Due to the discrepancy between clinical evaluation and histological findings, an EBUS-TBNA was performed 2 weeks after the mediastinoscopy. Probes were attained from lymph nodes at stations 4L, 4R, 11L, 7 as well as from the right main bronchus.
 One week later the patient was readmitted to the hospital due to fever and fatigue. The mediastinoscopy wound was lightly reddened and a small amount of serous fluid was easily evacuated after applying slight pressure on the wound. A computed tomography scan of the thorax was suspicious of a bronchomediastinal fistula depicting a pneumomediastinum ( Figs. 1 and 2 ), whereas a bronchoscopy confirmed the fistula showing a melting lesion on the right main bronchus ( Fig. 3 ). 
 The patient was then subjected to a right axillary thoracotomy; the pretracheal area until the tracheal bifurcation was partially loose but did not have any sign of an extended infection. Microbiological specimens from the site of the paratracheal tissue obtained during the surgical revision were negative. Specimens taken from the lesion site during the preoperative bronchoscopy were positive for Staphylococcus . The fistula with a size of a baby fingertip was located on the right main bronchus. A local debridement was done and the bronchial defect was directly closed with 4-0 PDS sutures and covered with the mobilized azygous vein. An extended biopsy of the enlarged lymph nodes was also performed. The patient was treated with antibiotics postoperatively. Postoperative bronchoscopy revealed a firm closure of the lesion ( Fig. 4 ). The mediastinoscopy wound healed easily without any further surgical measures. 
The patient recovered completely and was discharged 1 week later. Histology of the abundant specimens excluded again malignancy, showing anthracotic and histiocytic-altered lymphatic tissue, as well as an extended active perilymphadenitis matching to the local bronchomediastinal fistula.