Resume. The purpose of the study was to reveal the main features of the development of purulent mediastinitis in a wounded person with penetrating gunshot wounds of the chest and neck in order to further improve the diagnosis and treatment of this difficult complication. The work reports on the injured K., 29 years old, with acute purulent-necrotic mediastinitis and late bilateral empyema of the pleura caused by a gunshot wound to the chest and neck. With early diagnosis of suppurative mediastinitis due to penetrating gunshot wounds of the chest and neck, active surgical tactics including wound dressing, drainage, massive antibiotic therapy, and adequate postoperative care with intensive care generally help to save the patient's life.