Nonsurgical management of bilateral adrenal abscess in newborn with therapeutic aspiration under ultrasonographic guidance

Abstract

Neonatal adrenal abscess is a rare condition. Bilateral adrenal abscess are extremely rare. We present this case focusing on the usefulness of needle aspiration under ultrasonographic guidance. The bilateral suprarenal cystic masses are identified by ultrasonography and different sequences of magnetic resonance imaging.

Non-Surgical Management of Bilateral Adrenal Abscess in Neonates: Report of Two Cases

“…In both our cases, the abscess resolved with US-guided percutaneous drainage with appropriate antibiotic therapy, and no complications occurred during follow-up. The successful resolution of bilateral adrenal abscess with percutaneous drainage and intravenous antibiotics has also been reported by other authors [ 1 , 4 , 5 ].…”

“…Adrenal hemorrhage is not uncommon in neonates but the development of an adrenal abscess is extremely rare. Bilateral adrenal abscesses is even rarer with less than ten cases documented in the medical literature [ 1 - 5 ]. Neonates usually present with non-specific signs and symptoms which might result in delay in diagnosis and extension of the suppurative process to adjacent organs.…”

Adrenal abscess in a 3-week-old neonate – a case report

“…An adrenal abscess in a neonate is a sporadic clinical problem (fewer than 50 case reports ( 4 ) ). It is suspected to develop mainly because of a superinfection and inflammation within the site of previously extravasated blood to the adrenal gland, which is favored by the specific structure of this organ ( 2 , 5 , 6 ) . In neonates, the adrenal glands are relatively large, because of the presence of the persistent fetal cortex, and well-vascularized.…”

“…According to the literature, next to Escherichia coli , these bacteria are the most common pathogens of adrenal abscesses. There have been single cases of a neonatal adrenal abscess caused by group B Streptococcus , Bacteroides fragilis , Echovirus and Herpes simplex ( 5 , 6 ) .…”

“…The differential diagnosis of neonatal adrenal tumors must involve Wilm's tumor, neuroblastoma and a congenital urinary tract defect in the form of complete pelvicalyceal system duplication with dilatation of the upper segment and hydronephrosis ( 5 , 7 , 11 ) . Ultrasound images of adrenal hemorrhage and a hemorrhagic form of neuroblastoma can be identical.…”