The results of treatment of 53 patients with purulent mediastinitis were studied. The expediency to use the X-ray examination of the esophagus, mediastinum and esophago-fibroscopy was noted. In spreading of the inflammatory process to the TII1--TIV level, the cervical mediastinotomy was performed, below the TIV level--thoracotomy with wide opening of the mediastinum and its drainage, and that of a pleural cavity. Fourteen (26.4%) patients died from purulent complications.