The manuscript is devoted to ultrasound-assisted diagnosis of difficult airways and subsequent tracheal intubation with a video laryngoscope. The authors describe a patient with grade I obesity, previous several difficult laryngoscopies and tracheal intubations. Clinical death occurred during one of these procedures. Ultrasound confirmed an excessive thickness of the tongue (7.12 mm, difficult airways >6.10 mm) and large vertical distance from the highest point of hyoid bone to the lower jaw (20.13 mm, difficult airways > 20.0 mm). In addition, deformation of the right plate of thyroid cartilage and glottis deviation to the right and upward were revealed. Ultrasound data correlated with clinical assessment LEMON score 3 of difficult airways (beard, large tongue and snoring). Subsequently, laryngoscopy and tracheal intubation were performed using a hyperangulated laryngoscope (C-MAC D-BLADE «Karl Störz», Germany). Minor technical difficulties arose during passing the endotracheal tube through the vocal cords that could be associated with glottis deformation or use of hockey stick-type endotracheal tube guidewire. The last situation is typical for a hyperangulated laryngoscope.