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World J Clin Cases. Oct 26, 2026; 14(28): 127020
Published online Oct 26, 2026. doi: 10.12998/wjcc.127020
Point-of-care ultrasound-guided aspiration of a parapharyngeal abscess to facilitate airway management: A case report
Niranjani Balasubramanian, Saurabh Trivedi, Jitendra Kushwaha, Pooja Thaware, Anshu Priyanka Lakra, Ankita, Gaurav Trivedi
Niranjani Balasubramanian, Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Bhopal 462026, Madhya Pradesh, India
Saurabh Trivedi, Jitendra Kushwaha, Pooja Thaware, Anshu Priyanka Lakra, Ankita, Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal 462024, Madhya Pradesh, India
Gaurav Trivedi, Department of Radiation Oncology, All India Institute of Medical Sciences, Raebareli 229405, Uttar Pradesh, India
Co-first authors: Niranjani Balasubramanian and Saurabh Trivedi.
Co-corresponding authors: Saurabh Trivedi and Gaurav Trivedi.
Author contributions: Trivedi S and Balasubramanian N contributed to the clinical management of the patient, interpretation of the clinical findings, and preparation of the manuscript; Trivedi S conceptualised the case report, participated in airway management, performed the point-of-care ultrasound-guided aspiration, interpreted the procedural findings, and prepared the initial draft; Balasubramanian N contributed to acquisition and organisation of clinical data and critical revision of the manuscript; Kushwaha J and Thaware P contributed to patient management, interpretation of clinical findings, literature review, and critical revision of the manuscript; Lakra AP contributed to data collection, literature review, preparation of the figures, and development of the clinical timeline; Ankita contributed to data compilation, literature review, and critical review of the manuscript; Trivedi G contributed to literature review, scientific interpretation, manuscript editing, and critical revision for important intellectual content. Trivedi S, Balasubramanian N, and Trivedi G contributed to revision of the manuscript in response to peer-review and editorial comments; and all authors have read and approved the final manuscript and agree to be accountable for all aspects of the work. Balasubramanian N and Trivedi S have made important and complementary contributions to the completion of this case report and therefore qualify as co-first authors. Trivedi S was directly involved in the clinical and airway management of the patient, performed the point-of-care ultrasound-guided aspiration, conceptualised the case report, interpreted the procedural findings, and prepared the initial draft of the manuscript. Balasubramanian N contributed substantially to the clinical management of the patient, acquisition and organisation of clinical data, interpretation of the case, and critical revision of the manuscript. Both authors contributed significantly to the clinical documentation, interpretation, and preparation of the report, and their combined contributions were essential to the completion of the manuscript. Both Trivedi S and Trivedi G have played important and indispensable roles in the scientific development, interpretation, and preparation of the manuscript and therefore qualify as co-corresponding authors. Trivedi S conceptualised the report, coordinated the clinical and procedural aspects of the work, interpreted the airway-management strategy and point-of-care ultrasound-guided intervention, and prepared the initial manuscript draft. Trivedi G contributed substantially to the scientific interpretation of the case, comprehensive literature review, critical appraisal of the available evidence, manuscript editing, and revision for intellectual accuracy and clarity. Both authors contributed to refining the scientific presentation, interpretation of the findings, and final revision of the manuscript. Their complementary contributions were crucial to the completion and submission of the manuscript, and both share responsibility for correspondence concerning the scientific, clinical, and editorial aspects of the work.
AI contribution statement: The authors declare that no artificial intelligence tools were used in the preparation, writing, editing, analysis, interpretation, or revision of this manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and the accompanying clinical images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Saurabh Trivedi, Assistant Professor, Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Saket Nagar, Bhopal 462024, Madhya Pradesh, India. drst23@gmail.com
Received: August 20, 2026
Revised: October 9, 2026
Accepted: October 20, 2026
Published online: October 26, 2026
Processing time: 65 Days and 3.8 Hours
Abstract
BACKGROUND

Deep neck space infections involving the parapharyngeal region can cause severe upper-airway narrowing and make airway management hazardous because of anatomical distortion, edema, and proximity to major cervical vessels. Point-of-care ultrasound (POCUS) may assist by identifying an accessible collection and guiding aspiration in real time.

CASE SUMMARY

A 22-year-old man presented with progressive right-sided neck swelling, voice change, and worsening dyspnoea. 70° laryngoscopy showed a posterior pharyngeal wall bulge with mucosal edema and non-visualisation of the glottis. Contrast-enhanced computed tomography demonstrated a multiloculated parapharyngeal/posterior pharyngeal abscess measuring approximately 82 mm × 76 mm × 40 mm with marked oropharyngeal narrowing. A multidisciplinary airway plan was formulated. With spontaneous ventilation preserved, supplemental oxygen administered, and the patient semi-recumbent, POCUS-guided aspiration was performed through a right submandibular approach using colour Doppler and an 18-G, 5-cm echogenic needle. Approximately 60 mL of purulent material was aspirated from the largest safely accessible locule. The patient reported improved respiratory comfort and subsequently tolerated supine positioning. General anaesthesia was then induced, and first-attempt tracheal intubation was achieved using video laryngoscopy with a Cormack–Lehane grade 1 view. Definitive transoral surgical drainage followed. Culture grew Klebsiella pneumoniae susceptible to piperacillin–tazobactam. The patient was discharged after 7 days and remained asymptomatic at 3-month follow-up.

CONCLUSION

POCUS-guided aspiration may serve as a selective temporising adjunct in carefully chosen patients with severe airway narrowing and an accessible deep-neck collection. However, the observed improvement should be interpreted as temporal rather than proof of a causal increase in airway patency.

Keywords: Parapharyngeal space; Abscess; Airway management; Airway obstruction; Intubation; Intratracheal; Ultrasonography; Case report

Core Tip: Deep neck abscesses with severe pharyngeal distortion can make both awake airway instrumentation and induction of general anaesthesia challenging. In this case, a multiloculated posterior pharyngeal abscess caused marked oropharyngeal narrowing and non-visualisation of the glottis. Point-of-care ultrasound (POCUS)-guided partial aspiration was performed while spontaneous ventilation was maintained as part of an individualised multidisciplinary airway strategy, followed by successful video-laryngoscopic intubation and definitive surgical drainage. POCUS-guided decompression should be considered a selective temporising adjunct, not a replacement for established difficult-airway techniques.

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