Esophageal tuberculosis secondary to tuberculous mediastinal lymphadenopathy is a very unusual presentation of adult tuberculosis. We report a patient presenting with fever of unknown origin and dysphagia. Barium swallow demonstrated esophageal displacement, mucosal ulceration and perforation with a fistulous tract into the mediastinum. CT of the mediastinum gave the most complete delineation of the tuberculous mediastinal lymphadenopathy which surrounded and displaced the esophagus. The fistulous tract extending from the esophagus into the nodal mass was also seen on CT.