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 × 109/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.