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Imaging-Guided Percutaneous Needle Aspiration or Catheter Drainage of Neonatal Liver Abscesses: 14-Year Experience

¹ Division of Image Guided Therapy, Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Ave., Toronto, ON M5G 1X8, Canada.
² Present address: Diagnostic Radiology, St. Mary's Hospital, The Catholic University of Korea, Seoul, 150-713, South Korea.
³ Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.

OBJECTIVE. The purpose of our study was to review the clinical aspects and long-term outcomes of imaging-guided percutaneous aspiration or drainage of liver abscesses in neonates.

MATERIALS AND METHODS. We retrospectively reviewed the clinical and imaging records of eight neonates with liver abscesses referred for imaging-guided percutaneous aspiration or drainage, including one autopsy-proven case in whom the percutaneous aspiration or drainage was not performed. Clinical and imaging features, complications, and long-term follow-up results were assessed.

RESULTS. Eight neonates with liver abscesses were referred for imaging-guided percutaneous aspiration or drainage (five males, three females; age range, 7–100 days; weight, 610–3,400 g). Six were born prematurely (24–29 weeks of gestation). Six had a history of umbilical catheterization. All were clinically septic. All neonates received long-term IV antibiotics. Five neonates had solitary multiloculated abscesses (right lobe [n = 3], straddling both lobes [n = 2]), and three had solitary uniloculated abscesses (right lobe [n = 1] and left lobe [n = 2]). Imaging-guided drainage catheter insertion (n = 4), aspiration (n = 2), and aspiration followed by drainage catheter insertion (n = 1) were performed in seven neonates within 1 day after referral. Coagulase-negative Staphylococcus (4/8) was the most common organism isolated from blood and pus. There were no procedure-related complications. Catheter repositioning was required in one. Serial sonography (mean, 12.5 months) and clinical follow-up (mean, 20.7 months) showed complete clinical remission in seven cases. Three healed with calcification in the previous abscess site. Long-standing left portal vein thrombosis was seen in two cases.

CONCLUSION. Neonatal liver abscess is associated with good long-term outcome and minimal complications when imaging-guided percutaneous aspiration or drainage is performed in conjunction with long-term antibiotic coverage.

Keywords: drainage • interventional radiology • liver abscess • newborn • percutaneous aspiration

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