Patients with suspected esophageal perforations are routinely evaluated with a swallow study using a water-soluble contrast medium followed by thin-barium administration when the first fails to demonstrate a leak. Intrapleural barium instillation has been historically correlated with mild degree of pleural inflammation and a low-grade talclike reactive process. Still, if administered in excessive quantities, it may contribute to complicate the clinical scenario of pleural contamination secondary to the perforated esophagus. We report the case of a patient that presented with a malignant esophageal perforation and developed a trapped lung from extensive pleural contamination with barium sulfate that required video-assisted thoracic drainage and decortication with successful reexpansion of the lung and resolution of the acute symptoms.