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Distal femoral epiphyses appeared centrally . [27]. View Hani Makky Al Salam's current disclosures, see full revision history and disclosures, chronic recurrent multifocal osteomyelitis, alternating radiolucent and radiodense metaphyseal lines, Differential diagnosis of dense metaphyseal bands, normal variant:especially in a neonate - dense zone of provisional calcification, deprivation (psychosocial) dwarfism with trauma. Sumaira MacDonald, MBChB, PhD, MRCP, FRCR Lecturer, Sheffield University Medical School; Endovascular Fellow, Sheffield Vascular Institute, Sumaira MacDonald, MBChB, PhD, MRCP, FRCR is a member of the following medical societies: British Medical Association, Royal College of Physicians, and Royal College of Radiologists. Osseous changes occurred on CT in 69% of patients, and on computed chest radiography in 53%. Become a Gold Supporter and see no third-party ads. may show bands of increased density at the metaphyses can affect any metaphysis, but the involvement of the proximal fibula and distal ulnar metaphyses is highly suggestive may show bone-in-bone appearance abdominal radiographs utile for identification of exposure source and anatomic location if an ingestion is suspected 7 2001 Jun. Piomelli S. Childhood lead poisoning. By excluding more serious causes, this finding was proved to be a normal variant. 101(6):E7. Males and females are equally affected. Among young adults, bone lead levels greater than the degree of measurement uncertainty were confined entirely toindividuals who had grown up in housing that was estimated to have been built before 1955. Part of Springer Nature. A radiograph of the knee showing dense metaphyseal bands strongly supports the diagnosis of lead poisoning. Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Certain locations of missile fragments predispose the patient to lead poisoning or lead arthropathy. 1994 Apr. (2010) ISBN: 9781449976453 -. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . They revealed dense metaphyseal bands at both distal femoral physes with adjacent proximal horizontal bands of radiolucency suggestive of zone of provisional calcification with Trummerfeld zones. Mild flaring along metaphyseal corners was noted at distal femoral metaphysis suggestive of Pelkan spurs. The lead lines may persist after the lead exposure ends. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. [QxMD MEDLINE Link]. Case 4: bisphosphonate therapy - osteogenesis imperfecta, View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, Alternating lucent and dense metaphyseal bands. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-1572, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1572,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/lead-poisoning-1/questions/45?lang=us"}. Pelkan .. ADVERTISEMENT: Supporters see fewer/no ads. APPEARANCE Dense metaphyseal bands, less commonly known as dense metaphyseal lines, transverse bands, or "lead lines," indicate radiopaque bone (thicker than the adjacent diaphyseal cortex) at the metaphysis of growing bone, particularly at the wrists and knees ( Figs 1 , 2 ). skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages. (2010) ISBN: 9781437707922 -, 3. Lucent transverse metaphyseal lines (mnemonic). Since Biemond and Van Creveld first described the condition in 1939, a total of 7 cases of lead encephalopathy with a clinical presentation of a cerebellar tumor have been reported. MRI may demonstrate how the brain's functional maps undergo major reorganization in response to early environmental changes. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. At the time the article was last revised Daniel J Bell had American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Society of Nuclear Medicine and Molecular Imaging, American Association for Women Radiologists. 1981 Apr. [QxMD MEDLINE Link]. In our group we saw thin sclerotic metaphyseal bands and overall increased . Because lead and calcium are used interchangeably by bone, lead deposition occurs in high concentrations in growing bones; the greatest concentration occurs in the metaphyses, particularly those in the distal femora, ends of the tibiae, and distal radii, because these are the parts of the skeleton that grow most rapidly. Child is a known case of thalassemia. Radiological Society of North America, Inc. Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). (2014) ISBN: 9780071801843 -. CAS Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. Update on the clinical management of childhood lead poisoning. Wani AL, Ara A, Usmani JA. In 6 infants, there was evidence of multiple lead lines, indicating previous episodes of exposure to lead. Clinical manifestations vary, ranging from mild (or asymptomatic) cases to a severe life-threatening encephalopathy 6. At the time the article was last revised Francis Deng had no recorded disclosures. These bands were preceded and perhaps presaged by abnormalities of the metaphyses and growth plate that were present at birth. Become a Gold Supporter and see no third-party ads. Mosby Inc. (1996) ISBN:0815187092. (2019). 2. At the time the case was submitted for publication Imran Ahmad Khan had no recorded disclosures. Become a Gold Supporter and see no third-party ads. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures. Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. 1998 Jun. Radiology. Dense metaphyseal bands or lead lines indicate radioopaque bone at the metaphysis of growing bones and are fairly typical of lead poisoning in young infants with acute encephalopathy. Their results imply that MRS may depict metabolic abnormalities in individuals with lead poisoning. In addition, lead is used in containers for corrosive liquids (such as sulfuric acid); it may be toughened by the addition of a small percentage of antimony or other metals. Beverly P Wood, MD, MSEd, PhD is a member of the following medical societies: American Academy of Pediatrics, Association of University Radiologists, American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Medical Association, American Roentgen Ray Society, Radiological Society of North America, Society for Pediatric RadiologyDisclosure: Nothing to disclose. [8], With the advent of electrophysiology, it has become obvious that spinal cord involvement is the cause of lead neuropathy. Biomed Environ Sci. Please confirm that you would like to log out of Medscape. This is the origin of the word plumber and plumbing as lead has been widely used for water pipes in the home since Roman times, and also 'plumbism', a synonym for lead poisoning 5. physiological appearances in <3 years' age group, ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Now presented with severe knee pain. For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Radiology. Zou HJ, Ding Y, Huang KL, et al. Lead is a bluish-white metal of bright luster. {"url":"/signup-modal-props.json?lang=us"}, Datir A, Carroll D, Bell D, et al. 5. 4B, C). [QxMD MEDLINE Link]. skeletal dysplasias. Radiology 2008, Seen in up to 50% of patients with acute lymphoblastic leukemia, Believed to represent a disturbance of enchondral ossification, Most often seen in distal femur, proximal tibia (around knee), proximal humerus, distal radius, ulna, Lucent transverse band in the metaphysis of rapidly growing bones, Generally appear of uniform thickness across metaphysis, Congenital infections such as toxoplasmosis, rubella, cytomegalovirus, herpes and syphilis (TORCH infections), Any prior, severe, usually childhood illness. Taybi H, Lachman RS. Lead poisoning. The patient's brother worked part-time with him and developed similar findings; in addition, the brother had difficulty chewing and experienced dysphagia, perioral twitching, gynecomastia, and multifocal denervation of extremity and facial muscles. At the time the article was last revised Mostafa El-Feky had Also, see eMedicineHealth's patient education article Poisoning. Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Radiologists, Royal College of Surgeons of EnglandDisclosure: Nothing to disclose. Imaging: dense metaphyseal bands, suture separation due to lead encephalopathy (brain edema), dense ingested lead containing objects in GI tract Clinical: abdominal distension + pica Radiology Cases of Lead Poisoning Bone changes in hematologic disease. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. [QxMD MEDLINE Link]. Tax calculation will be finalised during checkout. High-resolution MRI and MRS were performed in both children by use of a 3-inch surface coil. Opaque metaphyseal bands in the lower femur, upper tibia, and the upper fibula secondary to lead poisoning in a child. J Environ Biol. 7. At the time the article was created Jeremy Jones had no recorded disclosures. Z Gesundh Wiss. Second Step. The infantile form of osteopetrosis ( Fig 17A ) features severe modeling failure of the metaphyses (Erlenmeyer-flask deformity) and may be accompanied by metaphyseal rachitic changes . [QxMD MEDLINE Link]. View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, alternating radiolucent and radiodense metaphyseal lines. Environ Health Perspect. Differential diagnosis Common chronic anemia, e.g. Include any more information that will help us locate the issue and fix it faster for you. A: Some of the common causes include chronic anemia, healing rickets and renal osteodystrophy. Radiology. Dense metaphyseal bands Case contributed by Dr Imran Ahmad Khan Diagnosis certain Share Add to Citation, DOI & case data Presentation Severe knee pain. 17(4):419-23. The patient had worked on refurbished houses, removing old paint, and complained of decreased cognition, fatigue, and muscle cramps. This increased metaphyseal opacity is a normal variant and represents exuberant calcification of the zone of provisional calcification. Fortschr Neurol Psychiatr. At the time the article was created Owen Kang had no recorded disclosures. Pediatrics. Previous autopsy studies have shown that cerebellar calcification is more common in Queensland than elsewhere. Subclinical lead exposure is associated with hyperuricemia. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. These images have been found to be reliable in young infants presenting with an unexplained encephalopathy. Gunshot wounds: 2. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. & Johnston, R. Dense sclerotic metaphyseal bands caused by denosumab therapy. Also have triad of hypertrophic callus formation, dense metaphyseal bands, and ossification of the interosseus membranes of the forearm. 38 (3):575-585. (1990) ISBN:0815176848. Lead poisoning. Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. Pediatrics. J Comput Assist Tomogr. 37 (5):231-46. Lead poisoning. Unable to process the form. Manifestations differ based on a myriad of features including chronicity, exposure intensity, and age. The mechanisms of contamination include ingestion, inhalation, prenatal exposure, and dermal exposure, but the most common are ingestion and inhalation. [QxMD MEDLINE Link]. Phenotypically indistinguishable from type IV OI. Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. lead. Perelman et al reported a case in which MRI results excluded a focal mass, and early treatment of edema prevented neurosurgical exploration. J Clin Endocrinol Metab 99:39543955, Department of Paediatric Radiology, Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast, BT, 12 6BE, UK, Department of Paediatric Oncology/Haematology, Royal Belfast Hospital for Sick Children, Belfast, UK, You can also search for this author in Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. Opaque metaphyseal bands are also seen after poisoning with other heavy metals; with hypervitaminosis D; and during the healing stages of leukemia, rickets, and scurvy. These metaphyseal bands, or lead lines, usually do not occur until blood lead levels (BLLs) reach 70-80 mcg/dL; they are not an early manifestation of lead intoxication. Unlike most other animals, humans cannot produce their own vitamin C. Lack of dietary vitamin C (ascorbic acid) may be related to inadequate food intake, the destruction of vitamin C in food caused by cooking and canning, or the absence of fresh fruit in the diet. These patterns were found in the subcortical area, basal ganglia, vermis, and cerebellum. More specifically, they found significant reductions in the levels of brain metabolites in gray matter but not white matter in individuals exposed to lead. Table 1. 2002 Dec. 49(6):1285-304, vii. 1. At the time the article was last revised Dijendra Nath Biswas had no recorded disclosures. Hu H, Milder FL, Burger DE. [14] Plain skeletal radiography revealed opaque metaphyseal bands in all 15 infants; these were best seen around the knee joint. Aminat S. Ogun, Neena V. Joy, Menogh Valentine. [1, 2, 3, 4, 5], Plain skeletal radiographs have been used extensively in the diagnosis of lead poisoning in children. The pellet was localized by means of 2-dimensional echocardiography of the left ventricular apical wall. K-shell x-ray fluorescence (KXRF) techniques have been used in epidemiologic studies to establish rates of environmental lead exposure in high-risk communities. 1988 May. bleeding gums, petechiae), and impaired wound healing. Sculpting the developing brain. Radiology Review Manual. Physiol Meas. Mutat Res. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 2002 May-Jun. The remainder had BLLs up to 21 mcg/g. 2018 Jun 1. Refer to the main article on differentials of dense metaphyseal bands. Trope I, Lopez-Villegas D, Cecil KM, Lenkinski RE. The neurobiology of brain reorganization during development is also being studied in light of new insights into the molecular mechanisms for activity-dependent neuronal plasticity. AD: IFITM5/BRIL: VI: Moderate to severe skeletal deformity. Muscle Nerve. Hu et al measured bone lead levels in 34 adults with no known history of excessive lead exposure and found that bone lead levels were greater in older persons; they concluded that theKXRF technique may help distinguish low levels of lead burden, as shown in epidemiologic studies. 48:1-38. [25], In another study, Trope et al concluded that lead has an effect on brain metabolites, as detected by MRS in vivo. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Bilateral, symmetrical, dense metaphyseal bands developtypically denser than the cortex of the adjacent metaphysis or diaphysis. Initially, the brain develops more neurons and synaptic connections than are needed for function in later life. 1996;34(1):107-8. 2021;:1-16. Share cases and questions with Physicians on Medscape consult. [19], CT plays a minor role in the diagnosis of lead poisoning. The images showed thick sclerotic bands in the metaphyses around the knee joints, findings that were attributable to her denosumab chemotherapy. Thalassemia is one of the known causes of dense metaphyseal bands. Pediatr Radiol. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Scurvy is a condition caused by a dietary lack of vitamin C (ascorbic acid), hence is also called hypovitaminosis C, and is characterized by an increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. Lead resists corrosion; in fact, lead pipes bearing the insignia of Roman emperors that were used as drains from the baths are still in service. [26]. All DeepDyve websites use cookies to improve your online experience. Zou et al studied the effects on systolic and diastolic cardiac function in 54 individuals exposed to lead and in 24 workers not exposed, and the Doppler echocardiographic results suggested that cardiac systolic function increased in the exposed group as a compensatory response to the effect of lead on myocardium. Schrote and associates reported a case of a 59-year-old potter who presented with lead polyneuropathy after 37 years of occupational exposure and noted that cranial CT showed extensive, bilateral, symmetrical calcification in the cerebellar hemispheres and minor calcification in the subcortical area of the cerebral hemispheres and basal ganglia. [7], Reyes et al described the CT findings of cerebral and cerebellar calcification in 3 adults with known exposure to lead of 30 years or longer, and on imaging, they found that the patterns of calcification varied and were punctiform, curvilinear, specklike, or diffuse. Ultrasonography is not routinely used in the diagnosis of lead intoxication, though transcranial sonography may be used to investigate congenital lead poisoning and lead intoxication in infant patients presenting with lead encephalopathy. "The Dense Metaphyseal Band Sign1.". 8. no financial relationships to ineligible companies to disclose. You are being redirected to At admission, the patients were found to have increased serum lead levels (54-72 mcg/dL; normal range, 0-30 mcg/dL). Unable to process the form. It is often seen in healthy children, especially after exposure to sunlight after winter. Sci Total Environ. A diagnosis of primary hyperoxaluria was . 2020 May;50(6):877-878. doi: 10.1007/s00247-020-04651-y. https://doi.org/10.1007/s00247-020-04651-y. Tutar HE, Atalay S, Uysalel A, et al. The overall appearances were suggestive of lead poisoning. AJR Am J Roentgenol. Seo J, Lee BK, Jin SU, Park JW, Kim YT, Ryeom HK, et al. 82(4):423-5. Fassin D, Naud AJ. MMWR Recomm Rep. 2007 Nov 2. Plain radiography of the knee is an inexpensive and widely available investigation that may be rapidly performed. Lead encephalopathy mimicking a cerebellar tumor. OS patients treated with pamidronate can develop metaphyseal sclerotic bands as well as epiphyseal and vertebral endplate sclerosis progressing to a bone-within-bone appearance. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. Caffeys Pediatric Diagnostic Imaging, 11th Ed. 1993 Apr. -. Effects of lead on systolic and diastolic cardiac functions. Mennel and John reported a case of a 23-month-old boy with osteosclerotic metaphyseal dysplasia (OMD). Curr Osteoporos Rep 15:283292, Kurucu N, Akyuz C, Ergen FB et al (2018) Denosumab treatment in aneurysmal bone cyst: evaluation of nine cases. 2007 Apr. Search The symptoms of lead encephalopathy are mainly those associated with cerebral edema. Although the pathophysiologic mechanism of these findings remains poorly understood, it has been suggested that chronic lead exposure be included in the differential diagnosis of unexplained intracranial calcifications in adults. Ahlgren L, Liden K, Mattsson S, Tejning S. X-ray fluorescence analysis of lead in human skeleton in vivo. In the study by Hu et al, 18 patients had bone lead levels below the measurement uncertainty. Postgrad Med J. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Evidence suggests that cerebellar calcification is a marker of previous lead intoxication. Lead toxicity and management of gunshot wounds in the lumbar spine. Stanley Leonard Robbins, Vinay Kumar, Ramzi S. Cotran. [29, 30, 31] Plain radiographs, CT, angiography, and sometimes MRI may all be used to localize the missile, to determine the path it followed in the body, to assess missile and bone fragmentation, and to identify missile emboli. You can use Radiopaedia cases in a variety of ways to help you learn and teach. [QxMD MEDLINE Link]. [from HPO] Term Hierarchy GTR MeSH CClinical test, RResearch test, OOMIM, GGeneReviews, VClinVar The distal ulna is unremarkable. Pediatr Radiol 50, 877878 (2020). The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. Pediatric Radiology Adv Pediatr. Angiology. Check all that apply - Please note that only the first page is available if you have not selected a reading option after clicking "Read Article". These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. Woolf AD, Goldman R, Bellinger DC. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Case study, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-83195. steroids, radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32), 1. 3. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. The decision was made at this time to commence treatment with pamidronate. No other abnormality was depicted on CT. a, b Anteroposterior ( a) and lateral ( b) projections both demonstrate thick . renal osteodystrophy; poisoning. Google Scholar, Kobayashi E, Setsu N (2015) Osteosclerosis induced by denosumab. sickle cell disease , thalassemia chemotherapy, e.g. Lead inhibits osteoclastic remodelling, but it has no effect on osteoblasts. Dense sclerotic metaphyseal bands caused by denosumab therapy Pediatr Radiol. Trope I, Lopez-Villegas D, Lenkinski RE. The classic findings of lead lines on radiographs of long bones are rarely seen because most cases of lead poisoning in children are due to exposures to low or moderate amounts of lead.

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