Background <p>Tracheal agenesis is a rare congenital airway malformation that may cause unexpected cannot ventilate, cannot intubate (CVCI) events at birth. Early recognition is critical, but the role of point-of-care airway ultrasound remains unclear.</p> Case presentation <p>A male neonate (35 + 1 weeks) was delivered by emergency cesarean section due to fetal distress, with prenatal findings suggesting duodenal atresia. Immediately after birth, he developed severe cyanosis and bradycardia. Bag-mask ventilation was ineffective, and intubation attempts failed despite glottic visualization. Point-of-care airway ultrasound demonstrated tracheal discontinuity, raising suspicion of tracheal agenesis. Esophageal intubation was performed, resulting in effective ventilation and stabilization. Tracheal agenesis (Floyd type II) was subsequently confirmed by computed tomography. The patient survives at 23 months with long-term ventilation via cervical esophagostomy.</p> Conclusion <p>Point-of-care airway ultrasound may facilitate rapid suspicion of tracheal agenesis and guide life-saving airway management in neonatal CVCI.</p>