An aorto-oesophageal fistula is a rare, life-threatening complication caused by sharp foreign bodies in the oesophagus. We report an aorto-oesophageal fistula in the inferior segment of thoracic oesophagus caused by a fish bone. Multiplanar reconstruction of computed tomography and computed tomography angiography demonstrated that a foreign body had pierced from the left posterior wall of the oesophagus into the descending aortic wall. These computed tomography images can help radiologists make the correct diagnosis and provide precise evidence for clinicians to perform a timely surgical intervention. In addition, a nodule in the upper lobe of the left lung was found by accident. The pathological finding after surgery revealed an invasive adenocarcinoma.