A patient with treated pulmonary tuberculosis and a thoracic aortic aneurysm was seen with a one-month history of dysphagia. Barium swallow revealed a mass in the lower esophagus and extravasation of contrast material into the mediastinum. Endoscopy and biopsy specimens showed acid-fast organisms. The patient was treated with antituberculous drug therapy but bled massively from the gastrointestinal tract and died. Autopsy revealed an aortoesophageal fistula at the level of the thoracic aneurysm. Histopathological study confirmed that this rare tuberculous lesion of the esophagus caused the fistula.