Thoracic complications of acute pancreatitis are mainly caused by the rupture of the main pancreatic duct leading to the diffusion of pancreatic juice into the mediastinum. Occasionally, esophagus or respiratory tract may also be involved. We report here the case of a 51-year-old man with acute alcohol-related pancreatitis who developed mediastinal and cervical infiltration through a wirsungo-mediastinal fistula caused by the leak of the main pancreatic duct which was successfully treated by splenopancreatectomy.