The Authors report a clinical case of lymph nodal cervical TBC which led to a retropharyngeal abscess with ossifluent evolution towards the mediastinal region and with fistulation in the dorsal region. A thorough study was carried out on the diffusion of the liquid along the fascial plains of the prevertebral region of the neck and of the mediastinum. With the aid of radiologic tools (CAT scans in particular), and on the basis of topographical anatomy data Authors formulate an hypothesis concerning the mechanics that brought about such a downward development of the abscess. In our opinion this case may well be of interest for otolaryngologists from an epidemic point of view (there is a recrudescence often in atypical manifestations), and because of its surgical peculiarities.