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The formation of a gastropleural fistula is an uncommon complication of a number of conditions. The case of a patient with gastropleural fistula, as a complication of gastric lymphoma, is presented. The patient developed a tension pneumothorax and empyema. On cytological examination of the empyematous fluid, the presence of food debris aided diagnosis. The patient died 2 days after a total gastrectomy. The development of this complication in gastric lymphoma appears to have a particularly poor prognosis.

Gastropleural fistula due to gastric lymphoma presenting as tension pneumothorax and empyema