Point-of-care ultrasound-guided aspiration of a parapharyngeal abscess to facilitate airway management: A case report

Table 1 Chronological timeline of clinical presentation, airway management, treatment, and follow-up

Time point	Clinical event
3 months before presentation	Progressive right-sided neck swelling began
Approximately 1.5 months before presentation	Voice change developed
5 days before presentation	Progressive dyspnoea developed, with worsening symptoms in the supine position
Day of presentation	HR 90/minute, BP 110/82 mmHg, RR 32 breaths/minute, SpO2 92% on room air. WBC 14000/mm3; CRP 4.6 mg/L
Initial airway assessment	Rigid 70° laryngoscopy showed a prominent posterior pharyngeal wall bulge with mucosal edema and non-visualisation of the glottis
Initial imaging	Contrast-enhanced CT demonstrated an approximately 82 mm × 76 mm × 40 mm multiloculated parapharyngeal/posterior pharyngeal collection with extension into adjacent deep-neck spaces and marked oropharyngeal narrowing
Emergency operating theatre	Multidisciplinary airway plan formulated; patient maintained semi-recumbent with spontaneous ventilation and oxygen via face mask
Pre-induction intervention	POCUS-guided submandibular aspiration performed using an 18-G, 5-cm echogenic needle under colour-Doppler and real-time ultrasound guidance; approximately 60 mL of pus aspirated
Immediately after aspiration	Patient reported improvement in respiratory discomfort and was able to tolerate supine positioning
Definitive airway management	General anaesthesia induced; video laryngoscopy demonstrated a Cormack-Lehane grade 1 view; tracheal intubation achieved on the first attempt
Same operative episode	Definitive transoral surgical drainage and irrigation performed
Postoperative period	Patient remained intubated and was managed in the ICU
Postoperative day 1	Extubated successfully without stridor or respiratory distress
Postoperative days 1-2	Continued ICU observation; no airway-related or respiratory complications
Postoperative day 3	Shifted to the ward
Hospital day 7	Discharged in stable condition without respiratory distress, dysphagia, recurrent neck swelling, or other airway-related symptoms
3-month follow-up	Patient remained asymptomatic, with no clinical evidence of recurrence and no need for repeat drainage; no follow-up CT or ultrasonography was performed

HR: Heart rate; BP: Blood pressure; RR: Respiratory rate; SpO₂: Peripheral oxygen saturation; WBC: White blood cell count; CRP: C-reactive protein; POCUS:Point-of-care ultrasound; ICU: Intensive care unit.