The aspects of acute purulent mediastinitis (APM) have been reported on the basis of the analysis of 14 cases treated in the last 5 years. The most frequent causes of APM were the complications after surgery on esophagus ad trachea (10 cases). The other group included patients operated on by sternotomy. Three patients survived. In both of them diagnosis was established within 12 hours from the beginning of APM and early re-thoracotomy was performed. The rest of the patients died because of sepsis and multiply organ failure (MOF). The conclusion is that only early diagnosis as well as aggressive surgical treatment give a chance to save life in such a dangerous severe complication.