A 33-year-old man with diabetes was referred to our hospital with the complaints of retrosternal pain, pharyngeal pain and high fever up to 39°C. He had history of fish bone ingestion 2 weeks previously. Examination of the heart and lungs was normal, and there were no apparent enlarged lymph nodes. The tumor markers were all within neutrophils. Subsequent chest contrast-enhanced CT showed diffuse thickening of esophageal wall in the middle and lower part, associated with inner low density similar to fluid. There were large quantities of gas retention in the lumen of esophagus, which suggested disorder of esophageal peristalsis in this region. Minimal effusion was also noticed in both pleural cavit. In combination with different data from this patient, esophageal abscess was first proposed. The patient accepted conservative treatment including nothing by mouth, broadspectrum antibiotics and intravenous fluid support for ten days. The patient’s symptoms improved significantly and his temperature recovered to be normal level. Follow-up CT revealed the disappearance of low attenuation within thickening esophageal wall and endoluminal air.