A 60-year-old woman presented with difficulty in breathing due to tracheal compression from limited stage small cell lung cancer (Fig. 1A). A prophylactic Niti-S stent (Taewoong Medical, Seoul, Korea) was deployed in the distal trachea before chemoradiotherapy. She then completed six cycles of carboplatin/etoposide chemotherapy over 5 months and mediastinal radiotherapy to a dose of 40 Gy in 15 fractions over 3 weeks. Three months after completion of her chemoradiotherapy, she developed irritating persistent cough. Computed tomography examination demonstrated a large tracheoesophageal fistula at the distal end of the stent (Fig. 1B) with bilateral consolidation due to aspiration. The fistula was bypassed by a 20/30 mm carinal Y Nitinol stent (Micro-Tech Europe, Nanjing, China; Fig. 1C) across the carina but the patient died due to worsening of acute respiratory distress syndrome. Iatrogenic tracheoesophageal fistula can be a fatal complication of endobnting, especially in patients having chemoradiotherapy. Papworth Hospital NHS Trust, Papworth Everard, Cambridgeshire, United Kingdom. Disclosure: The authors declare no conflicts of interest. Address for correspondence: Deepa Gopalan, MBBS, MSC, MRCP, FRCR, Papworth Hospital NHS Trust, Papworth Everard, Cambridgeshire CB23 3RE, United Kingdom. E-mail: deepa.gopalan@btopenworld.com Copyright © 2009 by the International Association for the Study of Lung Cancer ISSN: 1556-0864/09/0412-1572