Ultrasound in difficult airway in thyroid cancer: case report

Abstract

The use of ultrasound as a predictive tool for managing difficult airways (DAW) has established itself as a valuable resource in preoperative assessment. Unlike traditional clinical methods, ultrasound offers an objective, reproducible, and real-time assessment of airway anatomy. This case involves a 47-year-old patient diagnosed with thyroid cancer presenting with respiratory distress, who underwent a radical thyroidectomy and tracheostomy. Integrating ultrasound into airway assessment represents a significant step toward safer, personalized anesthesia—particularly for patients with anatomical abnormalities, such as those with thyroid pathology, for whom traditional methods may prove insufficient. In this instance, scanning the anterior cervical region revealed measurements (skin-to-epiglottis distance, skin-to-hyoid distance, and the E/E-VC ratio) consistent with established evidence. Anticipating a difficult airway in oncology patients—especially those with head and neck involvement—poses a major challenge for the anesthesiologist due to the significant compromise of upper airway structures, which affects both ventilation and intubation. Consequently, using ultrasound as a predictive tool is crucial for safe and efficient airway management, helping to minimize associated complications.