Adrenal abscesses: an uncommon and unexpected cause of the acute abdomen

Purpose Our purpose is to highlight the importance of advanced imaging for evaluation of adrenal abscesses along with pathological findings, facilitating an accurate differential diagnosis for acute abdomen presentations. Methods We performed a retrospective review of the available literature on adrenal abscesses, acute abdomen presentations, and abdominal imaging modalities. We highlight the five documented cases of adrenal abscesses since January 2023. We also review two cases of adrenal abscesses from our institution that demonstrate their clinical relevance in patients presenting with abdominal masses. Results Adrenal abscesses are very rare in practice with few cases documented in the literature. They most frequently occur due to disseminated infection, presenting with acute abdominal pain, weight loss, lightheadedness, and fever. Their presentation on imaging is characterized by a large, multiloculated lesion with peripheral enhancement. Treatment options include antimicrobial agents, surgical intervention, and percutaneous abscess drainage. Conclusion Adrenal abscesses may closely mimic other malignant and benign adrenal and abdominal masses. Due to their extreme rarity, they are often not included in the differential diagnosis of large abdominal masses. However, these lesions should be considered in acute abdomen presentations, especially with history of infection, to facilitate accurate and timely diagnosis and management.