An 8-month-old girl presented with 2 days of neck swelling and fever and a vague history of swallowing a fish bone. Radiography (Fig. 1) and CT (Fig. 2) revealed massive retropharyngeal and mediastinal emphysema. Urgent oesophagography showed cervical oesophageal perforation. The patient underwent successful repair of the perforation and drainage of the pleural and mediastinal spaces.