Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration as an Adjunctive Treatment in a Case of Descending Necrotizing Mediastinitis

Retropharyngeal abscesses are deep neck space infections that may progress to life-threatening complications, including descending necrotizing mediastinitis (DNM). Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique primarily used for sampling mediastinal lesions, though selected reports describe its adjunctive use in mediastinal abscess drainage. We present the case of a 51-year-old man with a retropharyngeal abscess extending into the superior posterior mediastinum. After cervicotomy with drainage and intravenous antibiotics, a residual mediastinal abscess was noted on CT. Given the favorable anatomical accessibility and the patient’s clinical stability, EBUS-TBNA was performed as an adjunctive drainage attempt, including intracavitary antiseptic irrigation. Follow-up CT demonstrated only minimal improvement, and definitive surgical debridement through uniportal video-assisted thoracic surgery was subsequently performed. The patient recovered without further complications. This case illustrates that EBUS-TBNA may serve as an adjunctive option for selected mediastinal abscesses when anatomical access is favorable. However, due to the limited drainage capacity of the needle, its therapeutic effect remains modest, and timely surgical debridement is essential in DNM. Further studies are required to clarify the role of EBUS-TBNA in mediastinal abscess management.