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CC BY 4.0 · Endoscopy 2025; 57(S 01): E911-E912
DOI: 10.1055/a-2665-7534
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Endoscopic ultrasound-guided drainage of a prevertebral neck abscess: a case report

Haojie He
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
,
Zecan Shi
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
,
Weigang Gu 
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
3   Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
4   Hangzhou Institute of Digestive Diseases, Zhejiang, China
,
Lei Lu
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
3   Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
4   Hangzhou Institute of Digestive Diseases, Zhejiang, China
,
Jianfeng Yang
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
3   Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
4   Hangzhou Institute of Digestive Diseases, Zhejiang, China
,
Xiaofeng Zhang 
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
3   Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
4   Hangzhou Institute of Digestive Diseases, Zhejiang, China
,
Hangbin Jin 
1   The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First Peopleʼs Hospital, Hangzhou, Zhejiang, China
2   Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Zhejiang, China
3   Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, China
4   Hangzhou Institute of Digestive Diseases, Zhejiang, China
› Author Affiliations
Supported by: 2024 Hangzhou Medical Health Technology Project A2024514
Supported by: Key R&D Program of Zhejiang Province No.2023C03054 No.2024C03048
Supported by: The Construction Fund of Key Medical Disciplines of Hangzhou 2025HZGF05
› Further Information
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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.

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Fig. 1 Cervical MRI revealing a prevertebral abscess at C4.
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Fig. 2 Reddish fluid aspirated from the abscess.
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Fig. 3 The follow-up CT scan revealing the drainage tube in an optimal position.
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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Publication History

Article published online:
20 August 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

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