Nonsurgical management of bilateral adrenal abscess in newborn with therapeutic aspiration under ultrasonographic guidance
A 26-days-old male neonate weighing 2.9 kg presented with a history of abdominal distention for the past 4 days. The neonate was delivered at term gestation in an institution. Clinical examination revealed an active infant having abdominal distention and palpable abdominal masses in bilateral upper quadrant. The laboratory data was unremarkable. Clotting test, renal function test, and urine examination were normal. Vanilmandelic acid, homovanilic acid, and catecholamine were normal. Ultrasonography was performed with Prosound-4000 (Aloka, Japan) ultrasound unit using 3.5 MHz curvilinear trasducer. Gray-scale sonography demonstrated cystic masses with internal echoes and debris at bilateral supra renal area measuring right 7.9 × 4.3 cm and left 4.4 × 4.6 cm, respectively [].\nColor Doppler and power Doppler imaging confirmed avascular nature of the mass. Magnetic resonance imaging of the abdomen was performed with a 1.5 T unit (Sigma; GE, U.S.A.) revealed well-defined bilateral suprarenal cystic masses measuring 7.5 × 5.6 cm on the right side and 4.0 × 4.5 cm on the left side. The masses were hypointense to muscle on T-1 weighted imaging and markedly hyperintense on T-2 weighted imaging [Figures and ]. A presumptive diagnosis of bilateral adrenal abscess was made.\nUltrasonographic guidance aspiration was done through posterolateral approach using a 20 gauge needle []. Ninety milliliters of thick pus was aspirated from right suprarenal abscess and 60 ml from left side and the aspirate was sent for bacteriological study. Abdominal distention was reduced within 24 h. Serial ultrasonography showed gradual regression of the residual adrenal cavities. The infant was discharged after 10 days of antibiotic therapy. The culture of aspirated purulent fluid revealed no growth and there was no clinical evidence of adrenal insufficiency. After 3-months follow up ultrasonography revealed the complete resolution of bilateral suprarenal mass with foci of calcification.