Tracheo-esophageal fistula following blunt thoracic trauma has been reported. Presence of a fistula must be anticipated when a young male patient has sustained blunt thoracic trauma, usually in an automobile accident. Some time after the third day the patient develops difficulty swallowing and appears to aspirate. An aggressive diagnostic approach relying primarily on endoscopy to precisely localize the site of the fistula is emphasized. Early primary repair of the fistula is recommended.