Dense metaphyseal bands | Radiology Case | Radiopaedia.org Goldfrank's Toxicologic Emergencies, Tenth Edition. W B Saunders Co. (1984) ISBN:0721673171. Robert Hoffman, Mary Ann Howland, Neal Lewin et al. A diagnosis of primary hyperoxaluria was . Lippincott Williams & Wilkins. Radiology. Am Fam Physician. A 30-minute measurement with an average estimated uncertainty of 6 mcg of lead per gram of bone mineral was obtained at the midtibial diaphysis. J Comput Assist Tomogr. The syndrome is clinically characterized by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase levels, and late-onset spastic paraplegia. You can see your Bookmarks on your DeepDyve Library. At the time the article was created Abhi Datir had no recorded disclosures. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. Pelkan .. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Eugen Fraenkel(1853-1925), a German pathologist, was the first person to be appointed a full Professor of Pathology at the University of Hamburg in 1919 6,8. Hu H, Milder FL, Burger DE. Dense metaphyseal bands Lucent transverse metaphyseal lines (mnemonic). At the time the article was created Mohammadtaghi Niknejad had no recorded disclosures. 8. Raber, S. (1999). Differential Diagnosis. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Radiographic findings in congenital lead poisoning. 1988 May. Common causes of dense transverse metaphyseal linescan be remembered using the mnemonics: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Dense Metaphyseal Bands and Lines | STATdx 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". J Neurol Neurosurg Psychiatry. Unable to process the form. Pediatrics. Generalized increased bone density in children | Radiology Reference Scurvy in adults is rare. Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). Thanks for helping us catch any problems with articles on DeepDyve. Lead exposure: health effects, prevention and treatment. Presenting features vary as a function of factors such as age (pediatric predisposition to more severe neurologic toxicity), ingested dose, and chronicity of exposure. 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. Evolution of the radiographic appearance of the metaphyses over the 1986 Feb. 146(2):245-7. 2008 Jul-Aug. 659(1-2):166-75. Stephen Chapman, Richard Nakielny. In healthy infants 3 years of age or younger, the finding of increased metaphyseal opacity is not unusual. Start a 14-Day Trial for You or Your Team. Dense metaphyseal bands HP:0100959 Dense radiopaque bands of bone which are thicker than the adjacent diaphyseal cortex and may form at the metaphysis of growing bones. [22]. [QxMD MEDLINE Link]. 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. 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. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . Lead encephalopathy: CT and MR findings. A negative radiograph does not rule out lead poisoning in children. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. no financial relationships to ineligible companies to disclose. Plumbism reinvented: childhood lead poisoning in France, 1985-1990. 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. [23]. milder pediatric cases may manifest with disturbances in behavior, growth, hearing and cognition, severe pediatric cases may progress to encephalopathy with seizures, coma, ataxia, cerebral edema, adults may similarly demonstrate mild (tired, irritable) symptoms or a severe encephalopathy, peripheral motor neuropathy may also develop, elevations (chronic) in zinc and erythrocyte protoporphyrin, may impair spermatic function and spermatogenesis, bone remodeling and growth may be affected in pediatric cases, with proposed mechanisms including 10, alterations in circulating endocrine factors such as parathyroid hormone and activated vitamin D, derangement in paracrine signaling factors such as osteocalcin, direct cellular toxicity, particularly affecting osteoclasts, growth trajectory and height may be affected, pathologically increased deposition of calcium in the zones of provisional calcification responsible for the dense metaphyseal bands on radiographs referred to as "lead lines", including aminolevulinic acid dehydratase and ferrochelatase 9, may impair production of erythropoeitin 6, erythrocyte functional and structural derangements, inhibition of erythrocyte sodium-potassium pump 8, predisposing to breakdown of the cell membrane and hemolysis, residual nucleotide clumps in cytosol appear as basophilic stippling, 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, abdominal radiographs utile for identification of exposure source and anatomic location if an ingestion is suspected 7, intra-luminal radio-opaque foreign body (or multiple punctate densities), serial radiographs may be used to monitor effectiveness of bowel decontamination, identification of source crucial to prevent ongoing toxicity 6, decontamination of ongoing sources of enteral absorption (paint chips, foreign bodies), some patients may require chelating agents to enhance elimination, also known as "British anti-Lewisite" or BAL, also known as succimer, the favored available oral chelating agent over d-penicillamine. 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. AJR Am J Roentgenol. 3. Reset filters. A 40-year-old man with end-stage kidney disease and calcium oxalate nephrolithiasis presented to the emergency department with joint pain. 2. Beverly P Wood, MD, MSEd, PhD Professor Emerita of Radiology and Pediatrics, Division of Medical Education, Keck School of Medicine, University of Southern California; Professor of Radiology, Loma Linda University School of Medicine Dense transverse metaphyseal lines (mnemonic) - Radiopaedia Johnston MV, Nishimura A, Harum K, et al. 2023 DeepDyve, Inc. All rights reserved. Clinical disorders such as lead poisoning may arise from disrupted brain plasticity. Gunshot wounds: 2. In addition, the serum activity of the MB isoenzymes of creatine phosphokinase (CPK-MB), one of the indices of myocardial damage, was significantly higher in the exposed group than that in control subjects; a positive correlation was found between CPK-MB activity and Pb-B. 1991 Oct. 59(10):413-24. see full revision history and disclosures, https://www.ncbi.nlm.nih.gov/books/NBK537329/, 1. Mutat Res. Clin Med (Lond). The radiographic findings of metaphysitis are diverse and include: Wimberger sign (typical erosion of the medial aspect of the proximal tibial metaphysis that presents in up to 30% of cases, mainly after the first month of life), transverse lucent metaphyseal bands (21-95%), transverse dense metaphyseal bands (14-26%), alternating dense and Check for errors and try again. Unable to process the form. [QxMD MEDLINE Link]. Had a bone marrow transplant recently. Medscape Education, 20021011549-overviewDiseases & Conditions, encoded search term (Lead Poisoning Imaging) and Lead Poisoning Imaging, Botulinum Toxin Injections in Plastic Surgery, Pathophysiology and Etiology of Lead Toxicity, EMA Panel Recommends DPD Testing Prior to Fluorouracil Treatment, Panel Backs Limited New Olaparib Use in Prostate Cancer, 'Snake Oil' Fake Cures for Long COVID Leave Patients at Risk, 10 Cases of Food Poisoning: Find the Pathogen Responsible. Bullets, ballistics, and mechanisms of injury. Ralph Weissleder, Jack Wittenberg, Mukesh G. Harisinghani. Plain abdominal radiographs may also guide therapy (eg, by allowing the prevention of further absorption through gastrointestinal decontamination). [15] In addition, this modality has been utilized to identify health effects resulting from lead exposure, but the equipment is bulky and requires significant maintenance and licensing procedures. Become a Gold Supporter and see no third-party ads. Part of Springer Nature. The child was advised to practice sports. Check for errors and try again. Epub 2020 Mar 18. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. 4. [17]. 1996;34(1):107-8. The pellet was localized by means of 2-dimensional echocardiography of the left ventricular apical wall. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Blickman JG, Wilkinson RH, Graef JW. 1998 Jun. Lead-induced impairments in the neural processes related to working memory function. Price excludes VAT (USA) Taybi H, Lachman RS. At the time the article was last revised Francis Deng had no recorded disclosures. Lead poisoning. 2. Bone-within-bone appearance in the spine and ossification centers was identified on computed radiography in 36%. X-ray fluorescence measurements of lead burden in subjects with low-levelcommunity lead exposure. 2014. This change was evidenced by increased A values and decreased E values and E/A ratios. Albers JW, Bromberg MB. Results of cranial CT, which is more sensitive than skull radiography, has confirmed that cerebellar and basal ganglia calcification occurs more commonly in patients examined in Queensland than in patients in North America. Year Book Medical Pub. Dense transverse metaphyseal lines (mnemonic). Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-12433, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":12433,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/hypovitaminosis-c-scurvy-1/questions/45?lang=us"}, View Mostafa El-Feky's current disclosures, see full revision history and disclosures, antineutrophil cytoplasmic antibodies (ANCA), 1. [QxMD MEDLINE Link]. 2016;9(10):1129-34. [13] These lines, which are actually growth arrest lines, are not pathognomonic for lead poisoning (see the images below). Radiological Society of North America, Inc. http://www.deepdyve.com/lp/radiological-society-of-north-america-inc/the-dense-metaphyseal-band-sign1-T1YzHA6HGA. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Specht AJ, Weisskopf MG, Nie LH. Skeletal Dysplasia Families: A Stepwise Approach to Diagnosis Theoretical modeling of a portable x-ray tube based KXRF system to measure lead in bone. 8. If normal BLLs are maintained, the lead lines gradually decrease in density and disappear after about 4 years. The affected child was also deficient in linguistic skills and attention mechanisms. 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. Piomelli S. Childhood lead poisoning. 56:1-16. Table 1. [Classification and Clinical Features of Osteogenesis 1903-4;7:231-265,291-310. Clinical manifestations vary, ranging from mild (or asymptomatic) cases to a severe life-threatening encephalopathy 6. Radiographs of the left knee in a 13-year-old girl about 1 year after she started treatment with denosumab. 1990 Apr. (2015) Interdisciplinary toxicology. Ahlgren L, Liden K, Mattsson S, Tejning S. X-ray fluorescence analysis of lead in human skeleton in vivo. Lead poisoning. Learning Radiology - Lucent Metaphyseal Bands in Leukemia Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. Sign up today, get DeepDyve free for 14 days. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-8549. methotrexate Such a band at the proximal end of the fibula is useful for diagnosis, since density in this area does not increase even with physiological dense metaphyses. The Dense Metaphyseal Band Sign1. Am J Public Health. By excluding more serious causes, this finding was proved to be a normal variant. Skeletal features of primary hyperoxaluria type 1, revisited These bands are not pathognomonic, and the differential diagnosis for cases involving opaque metaphyseal lines is wide and includes poisoning with other heavy metals; hypervitaminosis D; and the healing stages of leukemia,rickets, andscurvy. 2002 May-Jun. This increased metaphyseal opacity is a normal variant and represents exuberant calcification of the zone of provisional calcification. 1. Radiographic features of bisphosphonate therapy in pediatric - Springer Omare M, Kibet J, Cherutoi J, Kengara F. A Review of Tobacco Abuse and Its Epidemiological Consequences. 17(4):419-23. The Secret Life of the Periodic Table. Environ Health Perspect. Chelation therapy led to an increase in urine lead excretion without symptomatic improvement. CLINICAL VIGNETTE JBMR - American Society for Bone and Mineral Research Reassurance was given to the parents. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures. J Trop Pediatr. Plain radiography of the knee is an inexpensive and widely available investigation that may be rapidly performed. In select cases, abdominal radiographs may demonstrate paint chips or other objects. steroids, radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32), 1. 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. Check for errors and try again. The causes of generalized increased bone density in pediatric patients can be divided according to a broad category of causes:. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. Skeletal imaging effects of pamidronate therapy in osteosarcoma The lead lines may persist after the lead exposure ends. [QxMD MEDLINE Link]. The Roentgenogram in Early Scurvy. 1990 Oct. 155 (4):691-702. 1993 Apr. 139(1):81-5. Zou HJ, Ding Y, Huang KL, et al. Check for errors and try again. As with CT, MRI plays a minor role in the diagnosis of lead poisoning. Neuropsychological evaluation in the 2 cousins demonstrated areas of impairment in the lead-exposed child; these included difficulties in the academic skills of reading, writing, and arithmetic. Lead Poisoning | Pediatric Radiology Reference Article | Pediatric Postgrad Med J. Balani A, Golla N, Dey AK, Mahankali S, Seelam S. Image of the month: Intracranial calcifications due to chronic lead exposure. {"url":"/signup-modal-props.json?lang=us"}, Khan I, Dense metaphyseal bands. Check for errors and try again. [24]. Marta Hernanz-Schulman, MD, FAAP, FACR is a member of the following medical societies: American Institute of Ultrasound in Medicine, American Roentgen Ray SocietyDisclosure: Nothing to disclose. Read and print from thousands of top scholarly journals. Findings occur more frequently in younger patients with open epiphyses. Young children undergoing CT or MRI may need heavy sedation or general anesthesia. Refer to the main article on differentials of dense metaphyseal bands. Environmental sources may include 6: structural renovation (e.g. You are being redirected to
Biochemistry, Heme Synthesis. Skeletal imaging effects of pamidronate therapy in - PubMed Part 4 Musculoskeletal Imaging | Radiology Key Also, see eMedicineHealth's patient education article Poisoning. Wolfgang Dhnert. [QxMD MEDLINE Link]. (2019). flaking) results in incorporation in soil and/or dust contamination, degradation of lead-containing pipes and solder in plumbing, contamination of illegally distilled alcohol ("moonshine"), cooking spices, traditional remedies. Disturbance of enchondral bone formation can produce lucent metaphyseal bands (red arrows are oval) as in this patient with leukemia. Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, Society of Nuclear Medicine and Molecular ImagingDisclosure: Nothing to disclose. [28] A slightly elevated blood lead level (BLL) of the patient was alarming because of the possibility of subsequent lead poisoning associated with retained pellets. Previous autopsy studies have shown that cerebellar calcification is more common in Queensland than elsewhere. Radiology Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. Woolf AD, Goldman R, Bellinger DC. 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. 136(1):83-4. Scand J Work Environ Health. [7]. Pediatr Clin North Am. 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. Wonders of Radiology. - 173.236.152.13. Unable to process the form. [QxMD MEDLINE Link]. Lead environmental pollution is a major health hazard throughout the world. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-10519. [QxMD MEDLINE Link]. (2003) ISBN: 9780702026508 -, 5. Trope I, Lopez-Villegas D, Lenkinski RE. Dense metaphyseal bands (differential). Include any more information that will help us locate the issue and fix it faster for you. Fortschr Neurol Psychiatr. High-resolution MRI and MRS were performed in both children by use of a 3-inch surface coil. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. Common causes of dense transverse metaphyseal lines can be remembered using the mnemonics: DENSE LINES PRINCES Mnemonics DENSE LINES D: D-vitamin intoxication E: elemental arsenic and heavy metals ( lead, bismuth, phosphorus) N: normal variation S: systemic illness E: estrogen to mother during pregnancy L: leukemia, lymphoma I infection ( TORCH) STORCH) A: anatomical variation M: metastatic neuroblastoma E: earlier systemic illness ( rickets, scurvy) L: leukemia, lymphoma LINING L: leukemia, lymphoma Flora SJ. sanding) or senescence (e.g. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Deng F, et al. J Toxicol Clin Toxicol. 7. Certain locations of missile fragments predispose the patient to lead poisoning or lead arthropathy. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-65973, View Dijendra Nath Biswas's current disclosures, see full revision history and disclosures, alternating lucent and dense metaphyseal bands. The presence of lead foreign bodies in the gastrointestinal tract (caused by pica) may highlight the diagnosis and prompt immediate intervention. Dense metaphyseal bands (differential) Last revised by Francis Deng on 29 Jan 2020 Edit article Citation, DOI, disclosures and article data The differential diagnosis of dense metaphyseal bands is wide. [QxMD MEDLINE Link]. Radiological Society of North America, Inc. Dr Ben Still. [QxMD MEDLINE Link]. Ahlgren et al used x-ray fluorescence analysis to determine the lead concentration in vivo of 5 former workers in a metal industry and found that their lead levels were about 3-9 times higher than levels found in people from southern Sweden. 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. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. 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 Anton Sebastian. View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, alternating radiolucent and radiodense metaphyseal lines. Stanley Leonard Robbins, Vinay Kumar, Ramzi S. Cotran. Copy and paste the desired citation format or use the link below to download a file formatted for EndNote. Anne Paterson. 2002 Jan. 23(1):25-41. Mennel and John reported a case of a 23-month-old boy with osteosclerotic metaphyseal dysplasia (OMD).
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