The patient is a 77-year-old African American gentleman with a past medical history of pretension, diabetes mellitus, right upper lobe squamous cell lung cancer s/p radiation, immunotherapy and chemotherapy, benign prostatic hyperplasia, coronary artery disease heart failure with reduced ejection fraction with pacemaker placement who was recently underwent an EGD for evaluation of early satiety, nausea, vomiting and weight loss. EGD demonstrated a necrotic lesion in the right upper lateral wall of the esophagus with concerns of a fistula with direct connection with the mediastinum and RUL lung parenchyma. CT (Computed Tomography) scan without contrast of the neck and thorax demonstrated an esophageal -mediastinal RUL fistula.