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After the ingestion of a sharp-pointed fragment of bone and its esophagoscopic removal from a piriform sinus, an abscess developed in the neck above the clavicle. Roentgenograms after a barium swallow showed a perforation of the esophagus, with a bilocular abscess cavity extending horizontally and vertically into the superior mediastinum (figure). Sulfonamide drugs and penicillin given intramuscularly controlled the infection without surgical drainage.