If high lead levels persist, growth deformity, such as . 1. Am J Roentgenol Radium Ther Nucl Med. 1986 Feb. 146(2):267-70. Focal signs may predominate, mimicking a brain tumor in an area of generally diffuse brain edema. methotrexate Correspondence to (2003) ISBN: 9780702026508 -, 5. 2007 Apr. [26]. Reset filters. Radiology. [24]. 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. Woolf AD, Goldman R, Bellinger DC. Previous reports describe wide, dense metaphyseal bands and metaphyseal modeling changes in patients treated continuously and thin metaphyseal bands, increased bone density, increased growth, and decreased number of fractures in patients treated intermittently [2, 3, 5]. Dense Metaphyseal Bands and Lines With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. You are being redirected to The Hand in Radiologic Diagnosis, With Gamuts and Pattern Profiles. Thanks for helping us catch any problems with articles on DeepDyve. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. XRF-measured bone lead (Pb) as a biomarker for Pb exposure and toxicity among children diagnosed with Pb poisoning. Arch Environ Health. Lead poisoning or plumbismrefers to the multi-organ toxicity exerted by exposure to lead. Unable to process the form. Read and print from thousands of top scholarly journals. 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. Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). Check for errors and try again. Previous Section Next Section

EXPLANATION

Normal metaphyseal endochondral bone growth (in the zone of provisional calcification) requires the maintenance of a delicate balance between osteoblastic bone deposition and osteoclastic bone remodeling (. [9, 10]. The decrease in diastolic cardiac function was more significant in the lead-intoxication group than in the nonexposed group. 1993 Apr. Tutar and associates described a case of a 12-year-old girl who presented with recurrent pericardial effusion caused by a firearm pellet injury to the left ventricle. The mean lead concentration in the skeletons of the 5 metal workers was estimated to be 62 mcg/g; the standard error was 5 mcg/g. Acta Paediatr. Shubina O & Dudenkova N. The Effect of Lead on the Process of Spermatogenesis in Sex Glands of Male Albino Rats. The Effect of Lead on the Red Cell Membrane. (2003) ISBN: 0323023282 -, 2. 7. https://doi.org/10.1007/s00247-020-04651-y. Stephen Chapman, Richard Nakielny. Causes of lead poisoning include pica, industrial exposure, drinking moonshine liquor, gunshot wounds, retained lead pellets or particles, and a variety of folk remedies and cosmetics. 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. [QxMD MEDLINE Link]. Include any more information that will help us locate the issue and fix it faster for you. You can see your Bookmarks on your DeepDyve Library. Pediatric Radiology {"url":"/signup-modal-props.json?lang=us"}, Datir A, Carroll D, Bell D, et al. (2011) ISBN:1609139437. 107(6):1437-42. (2015) Interdisciplinary toxicology. The Secret Life of the Periodic Table. Semantic Type: Finding Semantic ID: T033 Concept ID: C4020919 ID . If you log out, you will be required to enter your username and password the next time you visit. [19], CT plays a minor role in the diagnosis of lead poisoning. 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. At the time the case was submitted for publication Imran Ahmad Khan had no recorded disclosures. Lead inhibits osteoclastic remodelling, but it has no effect on osteoblasts. Case 4: bisphosphonate therapy - osteogenesis imperfecta, View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, Alternating lucent and dense metaphyseal bands. Require these words, in this exact order. 1988 May. 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. 2. Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. 1990 Oct. 155 (4):685-90. GBS looks like RDS, with bilateral granular, symmetric opacities and low lung volumes GBS usually has effusions and RDS rarely does other pneumonias resemble meconium aspiration, w/ patchy, asymmetric opacities and hyperaeration organisms - Group B Strep, CMV (viral pneumonitis), Chlamydia Low Volume Pulmonary Opacification Pneumonia Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. In our group we saw thin sclerotic metaphyseal bands and overall increased . Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. Angiology. 2002 Dec. 49(6):1285-304, vii. W B Saunders Co. (1984) ISBN:0721673171. - 173.236.152.13. [21] The subjects' childhood residence and occupational status provided circumstantial evidence of a relationship between excessive lead intake and cerebellar calcification, as seen on CT scans. Arch Pediatr Adolesc Med. Sci Total Environ. [24]. Anne Paterson. Copy and paste the desired citation format or use the link below to download a file formatted for EndNote. By excluding more serious causes, this finding was proved to be a normal variant. Google Scholar, Kobayashi E, Setsu N (2015) Osteosclerosis induced by denosumab. If the lead exposure is prolonged, there may be lack of bone modeling. In select cases, abdominal radiographs may demonstrate lead-containing paint chips (resulting from pica) or other lead-containing objects. [QxMD MEDLINE Link]. Analysis of the metaphyseal bone changes should help distinguish OMD from lead poisoning and other causes of metaphyseal sclerosis. Am J Public Health. [QxMD MEDLINE Link]. 36(2):90-3. 2002 Jan. 23(1):25-41. [11] They described a 43-year-old man who was referred by a veterinary surgeon who evaluated the man's dog for a seizure; the veterinarian suspected a toxic lead exposure in both the dog and its owner. [6]. Raber, S. (1999). The mechanisms of contamination include ingestion, inhalation, prenatal exposure, and dermal exposure, but the most common are ingestion and inhalation. Single transverse lines predominate, but multiple bands may be seen in cases of episodic lead poisoning. Perelman et al reported a case in which MRI results excluded a focal mass, and early treatment of edema prevented neurosurgical exploration. Anteroposterior radiograph of the knees in a 5-year-old girl reveals very dense metaphyseal bands in the distal femurs and proximal tibias (arrows) as well as in the proximal fibulas (arrowheads). volume50,pages 877878 (2020)Cite this article. J Toxicol Clin Toxicol. The differential diagnosis for lucent transverse metaphyseal lines or bands may be recalled using various mnemonics: CAMEL LINING Mnemonics CAMEL C: congenital infection (e.g. 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 4. [QxMD MEDLINE Link]. (adsbygoogle = window.adsbygoogle || []).push({}); Lucent Metaphyseal Bands in Leukemia. dense metaphyseal bands: differential and mnemonic lucent metaphyseal bands Electrochemical CO2 reduction to C2+ products using Cu-based electrocatalysts: A review Touqeer Ahmad et al., Nano Research Energy, 2022 Photo-enhanced rechargeable high-energy-density metal batteries for solar energy conversion and storage (2010) ISBN: 9781449976453 -. A normal skeletal radiograph does not rule out lead poisoning in children. Mild flaring along metaphyseal corners was noted at distal femoral metaphysis suggestive of Pelkan spurs. [QxMD MEDLINE Link]. Karl Francis Pelkan(1890-1992), an Austrian-American pediatrician described his eponymous spurs in a paper published in 1925 6,7. differential diagnosis for dense metaphyseal bands, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. [QxMD MEDLINE Link]. Chelation therapy led to an increase in urine lead excretion without symptomatic improvement. Sachs HK. The Roentgenogram in Early Scurvy. [QxMD MEDLINE Link]. 17(4):419-23. Woolf DA, Riach IC, Derweesh A, Vyas H. Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test. OMD is a rare sclerosing bone disorder inherited in an autosomal recessive manner. 2. You can use Radiopaedia cases in a variety of ways to help you learn and teach. Become a Gold Supporter and see no third-party ads. 1925;30(2):174. 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. At the time the article was last revised Francis Deng had no recorded disclosures. Goldfrank's Toxicologic Emergencies, Tenth Edition. Become a Gold Supporter and see no third-party ads. CAS 50(4):337-40. These patterns were found in the subcortical area, basal ganglia, vermis, and cerebellum. 2004;94 (11): 1854-63. Mennel EA, John SD. 1903-4;7:231-265,291-310. Eur Spine J. 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. 9. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. 4B, C). Plain abdominal radiographs may also guide therapy (eg, by allowing the prevention of further absorption through gastrointestinal decontamination). 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. 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. Variable scleral . Pediatr Clin North Am. [QxMD MEDLINE Link]. The syndrome is clinically characterized by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase levels, and late-onset spastic paraplegia. [13] These lines, which are actually growth arrest lines, are not pathognomonic for lead poisoning (see the images below). 1995 Dec. 8(4):281-8. You can change your cookie settings through your browser. 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 82(4):423-5. In addition, T2-weighted MRI showed high signal intensity in the periventricular white matter, basal ganglia, insula, posterior thalamus, and pons. Clinical manifestations vary, ranging from mild (or asymptomatic) cases to a severe life-threatening encephalopathy 6. [25] One, a 10-year-old boy, had elevated blood lead levels (BLLs). Disrupted brain plasticity is not confined to cases of lead intoxication; other clinical disorders, such as metabolic and epileptic encephalopathies, as well as psychosocial deprivation, may be associated with disrupted brain plasticity. Become a Gold Supporter and see no third-party ads. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. Clinical disorders such as lead poisoning may arise from disrupted brain plasticity. 2. Radiological Society of North America, Inc. http://www.deepdyve.com/lp/radiological-society-of-north-america-inc/the-dense-metaphyseal-band-sign1-T1YzHA6HGA. skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages. [QxMD MEDLINE Link]. Vet World. Tax calculation will be finalised during checkout. {"url":"/signup-modal-props.json?lang=us"}, Salam H, Deng F, Bell D, et al. This website also contains material copyrighted by 3rd parties. [QxMD MEDLINE Link]. The pellet was localized by means of 2-dimensional echocardiography of the left ventricular apical wall. 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. At the time the article was created Mohammadtaghi Niknejad had no recorded disclosures. Dense vertical striations about the metaphyses are less common than transverse bands and are found in a selected group of disorders. The distal ulna is unremarkable. Also have triad of hypertrophic callus formation, dense metaphyseal bands, and ossification of the interosseus membranes of the forearm. [1, 2, 3, 4, 5], Plain skeletal radiographs have been used extensively in the diagnosis of lead poisoning in children. Osseous changes occurred on CT in 69% of patients, and on computed chest radiography in 53%. [QxMD MEDLINE Link]. Exposure to lead appears to selectively alter metabolism of cortical gray matter. [12] The patient presented with hypotonia, developmental delay, and complex seizures. 21 (4):347-52. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. 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. steroids, radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32), 1. This process is thought to be the basis for the plasticity of the developing brain or its capacity to adapt in behavior and circuitry in response to stimulation from the external environment. 2016 Oct. 16 (5):494. The differential diagnosis for lucent transverse metaphyseal lines or bandsmay be recalled using various mnemonics: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Woolf and associates examined 15 Omani infants (2-4 mo of age) who had acute lead encephalopathy and concluded that any young infant presenting with unexplained encephalopathy should undergo radiography of the knee and that, in such cases, the presence of opaque metaphyseal bands strongly supports the diagnosis of lead poisoning. 4. MMWR Recomm Rep. 2007 Nov 2. Child is a known case of thalassemia. Lead toxicity and management of gunshot wounds in the lumbar spine. Perelman S, Hertz-Pannier L, Hassan M, Bourrillon A. However, prominent vertical trabecular formation may also represent normal anatomical variation in otherwise normal subjects. Tutar HE, Atalay S, Uysalel A, et al. 2001. Sign up today, get DeepDyve free for 14 days. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. Year Book Medical Pub. MRI may demonstrate how the brain's functional maps undergo major reorganization in response to early environmental changes. Radiographs of the left knee in a 13-year-old girl about 1 year after she started treatment with denosumab. 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. Curr Rev Musculoskelet Med 9:435444, Article BLLs were normal. Hollerman et al describe the substantial contribution radiologists can make to the evaluation and treatment of the patient with a gunshot wound. Normal bone is laid down on the epiphyseal side of the lead line; with recovery, the lead line becomes broader and less dense and may eventually disappear. 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. Radiology Trope et al found that that magnetic resonance spectroscopy (MRS) may have a role as a noninvasive technique for the in vivo examination of the brain of children exposed to lead. ADVERTISEMENT: Supporters see fewer/no ads. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. Pulsed Doppler imaging showed that time-related parameters were comparablein all groups but that blood flow velocity through the mitral valve and Doppler area fractions changed significantly in lead-exposed groups. [QxMD MEDLINE Link]. J Environ Biol. Fortschr Rontgenstr. Reassurance was given to the parents. The common occurrence of renal impairment in these patients may be the result of associated lead nephropathy. Two patients developed chronic renal disease and hypertension; in both, serum parathormone levels were elevated; serum calcium and phosphorus levels were normal in all 3. At the time the article was last revised Mohammadtaghi Niknejad had Bookmarks. A mild anemia and elevated serum and urine lead levels supported a diagnosis of lead neuropathy. 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. the dense metaphyseal bands and generalized osteopenia persisted, and there was clear progression of the calcification of the interosseous membrane of the forearm (Fig. no financial relationships to ineligible companies to disclose. [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. renal osteodystrophy; poisoning. 1998 Jun. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. Although no distinctive neurologic syndrome could be demonstrated, the incidence of hypertension and hyperuricemia was increased in the affected patients, and serum creatinine levels were increased. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . [QxMD MEDLINE Link]. Unable to process the form. 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. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. [QxMD MEDLINE Link]. [Full Text]. link. 10. Manifestations differ based on a myriad of features including chronicity, exposure intensity, and age. Albers and Bromberg reported a case of X-linked bulbospinomuscular atrophy, or Kennedy disease, masquerading as lead neuropathy. Share cases and questions with Physicians on Medscape consult. This patient was encephalopathic and anemic and had a lead level of 60 g/dL (2.898 mol/L) at admission. Also, see eMedicineHealth's patient education article Poisoning. Symmetric dense metaphyseal bands are noted in the lower end of femur and upper end of tibia and fibula. These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. https://doi.org/10.1007/s00247-020-04651-y, DOI: https://doi.org/10.1007/s00247-020-04651-y. 56:1-16. 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. Become a Gold Supporter and see no third-party ads. Pediatrics. Both underwent a comprehensive neuropsychological evaluation. The term scurvy comes from various words used to describe the manifestations of the condition:covered with scabs, diseased, scorbutic. 5. PLoS One. Anton Sebastian. The hypothesis of axonal degeneration in the dying-back variant, starting in the biochemical lesion of perikarya of the anterior horn cells in the spinal cord, is in full agreement with both the electromyographic signs of denervation and the electroneurographic normal range of conduction velocity. StatPearls Publishing. Findings occur more frequently in younger patients with open epiphyses. Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. 11. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. Z. V. Maizlin. [27]. The decision was made at this time to commence treatment with pamidronate. 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. 1. At the time the article was last revised Mostafa El-Feky had 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. Pediatrics. [QxMD MEDLINE Link]. [17]. Hu H, Milder FL, Burger DE. bleeding gums, petechiae), and impaired wound healing. Young children undergoing CT or MRI may need heavy sedation or general anesthesia. 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. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Evidence suggests that cerebellar calcification is a marker of previous lead intoxication. [QxMD MEDLINE Link]. 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 Dense transverse metaphyseal lines (mnemonic). Pelkan .. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Deng F, et al. 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. AJR Am J Roentgenol. 2008 Jul-Aug. 659(1-2):166-75. 1994 Apr. Select data courtesy of the U.S. National Library of Medicine. AJR Am J Roentgenol. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dense Metaphyseal Bands and Lines. 3. At the time the article was last revised Dijendra Nath Biswas had no recorded disclosures. Other clinical disorders, such as metabolic and epileptic encephalopathies and psychosocial deprivation, may be associated with disrupted brain plasticity. (2010) ISBN: 9781437707922 -, 3. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Pediatr Blood Cancer 65, Wang H, Boyce A, Tsai J et al (2014) Effects of denosumab treatment and discontinuation on human growth plates. Lead encephalopathy mimicking a cerebellar tumor. Blickman JG, Wilkinson RH, Graef JW. In 4 infants, lead lines were also seen in the axial skeleton. Fortschr Neurol Psychiatr. 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. Unable to process the form. [Full Text]. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDEwMTEzLW92ZXJ2aWV3. The patient in the study by Schrote et al had a 25-year history of normochromic normocytic anemia with moderate basophilic stippling, mild renal failure, hyperuricemia, and abnormal porphyrins. Radiographic findings in congenital lead poisoning. 1976 JUN. (2019). Anecdotal reports of angiography and ultrasonography used in the diagnosis of lead poisoninghave appeared in the literature. 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. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. Environmental sources may include 6: structural renovation (e.g. Theoretical modeling of a portable x-ray tube based KXRF system to measure lead in bone. Biomed Environ Sci. Radiological Society of North America, Inc. Their results imply that MRS may depict metabolic abnormalities in individuals with lead poisoning.