The Role of Real-Time Contrast-Enhanced Ultrasound in Guiding Radiofrequency Ablation of Reninoma: Case Report and Literature Review

Abstract

BackgroundReninoma is a rare renal endocrine tumor that can cause secondary hypertension, characterized by hypertension, hypokalemia, high renin and aldosterone with normal aldosterone renin ratio (ARR), and occurs more in young female. Mainstream treatment option is surgery, but is less suitable for small or deep lesions, which makes ablation a promising alternative.Case presentationTwo young female with typical manifestations of reninoma, including hypertension, hypokalemia, high renin, high aldosterone and normal ARR, were treated successfully with real-time contrast-enhanced ultrasound guided radiofrequency ablation, and contrast-enhanced ultrasound was also performed before and after treatment for diagnosis and postoperative assessment. Afterward, their blood pressure and laboratory tests became normal and remained steady during the follow-up of 32 and 6 months, respectively.ConclusionContrast-enhanced ultrasound guided radiofrequency ablations is a promising alternative for reninoma treatment with comparable safety and efficacy with surgery, and has advantages especially in small or deep lesions.

Interaction Between Microbubbles and Microwave Ablation

“…Some studies have encouraged the use of CEUS during thermal ablation. 2,[5][6][7] Considering that microbubbles are the main components of ultrasound contrast agent, exploring the mutual influence of MWA and microbubbles is important and clinically valuable. In this study, our results indicated that although MBs (SonoVue) had no significant influence on MWA, MWA could induce the destruction of microbubbles in a temperature-dependent manner.…”

“…3,4 Furthermore, some studies have encouraged the use of CEUS to monitor thermal ablation in real time. 2,[5][6][7] Therefore, microbubble injections could be a commonly performed during thermal ablation. However, the precise predicting and real-time monitoring requirements for the ablation range are becoming increasingly strict in clinic.…”

“…For example, CEUS can detect small tumors that are invisible on conventional US 1,2 and contribute to ablation guidance 3,4 . Furthermore, some studies have encouraged the use of CEUS to monitor thermal ablation in real time 2,5–7 . Therefore, microbubble injections could be a commonly performed during thermal ablation.…”

Juxtaglomerular cell tumor：how to identify this rare disease by ultrasound?

“…In our study, four tumors, with small size (1.0~1.5cm) and located completely in the cortex with no protrusion, were missed by ultrasound. Contrast enhanced ultrasound might be helpful [4,18]. Li et al reported two cases of JGCT, invisible by previous conventional ultrasound, found by contrast enhanced ultrasound.…”

“…The tumor is also called reninoma because it can secrete renin [1,2]. Since the rst report of JGCT in 1967 [3], fewer than 200 cases have been reported in the literature [4]. It is more common in young females aged 20-39 years, with a male: female ratio of 1:2 [5].…”