Endoscopic ultrasound-guided drainage of a prevertebral neck abscess: a case report

A 73-year-old male presented with a 20-day recurrent fever (peak 40.2°C) without any symptoms. Laboratory findings showed neutrophilia (7.2 × 10 ⁹ /L, 82.8%), elevated CRP (219 mg/L) and PCT (0.83 ng/mL), and blood cultures positive for Klebsiella pneumoniae bacteremia, prompting meropenem therapy. Subsequent posterior neck pain and progressive upper limb weakness prompted cervical magnetic resonance imaging (MRI), revealing a 32 mm × 19 mm × 29 mm prevertebral abscess anterior to C4 ( Fig. 1 ). Due to its deep location and proximity to neurovascular structures, conventional percutaneous ultrasound or computed tomography (CT)-guided drainage was deemed high-risk. A multidisciplinary team (MDT) opted for endoscopic ultrasound (EUS)-guided drainage. EUS identified a 32.5 mm × 25.9 mm hypoechoic mass with patchy hyperechoic areas in the posterior hypopharyngeal wall. The abscess was punctured with a 19-G needle, and reddish fluid was aspirated ( Fig. 2 ). A guidewire was inserted into the abscess cavity. After dilation by using a cystotome, a drainage tube was placed ( Video 1 ). The follow-up CT scan revealed the drainage tube in an optimal position ( Fig. 3 ). Pus culture confirmed K. pneumoniae . However, nonliquefaction of the abscess resulted in limited fluid drainage. Thereafter, the patient was transferred to orthopedic surgery.

Fig. 1.

Cervical MRI revealing a prevertebral abscess at C4.

Fig. 2.

Reddish fluid aspirated from the abscess.

Fig. 3.

The follow-up CT scan revealing the drainage tube in an optimal position.

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EUS-guided drainage of a prevertebral neck abscess.

Video 1

The prevertebral space, extending from the skull base to coccyx, is prone to abscess formation secondary to spinal degeneration, infection, or trauma, necessitating early drainage to prevent spinal cord compression ¹ . While ultrasound-guided drainage matches surgical efficacy with lower invasiveness ² , EUS offers distinct advantages: trans-luminal access via natural orifices shortens puncture distance, enables real-time needle visualization (reducing neurovascular injury risk), and avoids skin puncture (minimizing exogenous infection) ^{3 4} . This represents the first reported EUS-guided drainage of a prevertebral abscess, highlighting its utility for deep-seated lesions adjacent to the digestive tract.

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