This study reported a rare case of mediastinal abscess scrofula. The patient was found to have a large left main bronchial orificium fistula (approximately 1.5x1.5cm in size) after clearing a mediastinal lymph node abscess via the right thoracotomy approach. The adjacent tissue was empty and could not be directly repaired. Therefore, the research team cut out an appropriately sized right pericardial fat pad patch during the operation for repairing and then covered it with a biological patch (Neoveil) for reinforcement. The mediastinal pleura was treated by embedding and the postoperative recovery was good.