An investigation of the formal patho-genesis of the so-called intramural esophagus diverticulosis is carried out on a case confirmed by autopsy. The roentgenological diagnosis corresponded morphologically with a proliferation of sub-mucous esophagus glands and a dilatation of their outlets, a portion of which displayed platelet epithelial metaplasia. Diverticle formation is feigned by widening, predominantly of the outlets, which could be traced into the muscular wall layers. In the present case esophagitis with attendant inflammation along the outlets lead to fistula formation into the anterior mediastinum with attendant mediastinitis. Aspirations were due to constrictions of the esophagus lumen. The patient came to exitus as a result of purulent abscessing aspiration pneumonia complicated by pulmonary artery emboli.