Computed tomography is currently used as an adjunct to oral contrast studies in the diagnosis and management of esophageal and posterior pharyngeal perforation. We present the CT findings of a surgically proven iatrogenic pyriform sinus perforation. Although extravasation of contrast material was depicted by pharyngography, the site of perforation could not be demonstrated. Knowledge of the pattern of spread of pharyngeal neoplasms was essential for correct interpretation of CT. In our patient the perforation was caused by traumatic passage of an Ewald tube, an unusual and previously unreported complication.