[QxMD MEDLINE Link]. Rentfrow B, Vaidya R, Elia C, Sethi A. Z Gesundh Wiss. volume50,pages 877878 (2020)Cite this article. Both underwent a comprehensive neuropsychological evaluation. Omare M, Kibet J, Cherutoi J, Kengara F. A Review of Tobacco Abuse and Its Epidemiological Consequences. Update on the clinical management of childhood lead poisoning. Start a 14-Day Trial for You or Your Team. Check for errors and try again. XRF-measured bone lead (Pb) as a biomarker for Pb exposure and toxicity among children diagnosed with Pb poisoning. 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. It is often seen in healthy children, especially after exposure to sunlight after winter. Plain radiography of the knee is an inexpensive and widely available investigation that may be rapidly performed. 17(4):419-23. 2022. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. CAS Reset filters. Radiographic findings in congenital lead poisoning. Marta Hernanz-Schulman, MD, FAAP, FACR Professor, Radiology and Radiological Sciences, Professor of Pediatrics, Department of Radiology, Vice-Chair in Pediatrics, Medical Director, Diagnostic Imaging, Vanderbilt Children's Hospital Dr Ben Still. At the time the article was created Abhi Datir had no recorded disclosures. drug or hormone therapy in high dosage,e.g. [22]. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-21388. Certain locations of missile fragments predispose the patient to lead poisoning or lead arthropathy. Become a Gold Supporter and see no third-party ads. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. 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. The mechanisms of contamination include ingestion, inhalation, prenatal exposure, and dermal exposure, but the most common are ingestion and inhalation. Differential diagnosis Common chronic anemia, e.g. & Johnston, R. Dense sclerotic metaphyseal bands caused by denosumab therapy. no financial relationships to ineligible companies to disclose. At the time the article was created Mohammadtaghi Niknejad had no recorded disclosures. 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. [QxMD MEDLINE Link]. {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. Wonders of Radiology. These findings suggest that an increase in lead burden leads to an increase in the release of CPK-MB from the myocardial cells and that slight myocardial damage occurs, which might conceivably impair diastolic cardiac function. Radiology Review Manual. Pediatr Blood Cancer 65, Wang H, Boyce A, Tsai J et al (2014) Effects of denosumab treatment and discontinuation on human growth plates. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. Subclinical lead exposure is associated with hyperuricemia. Ahlgren L, Liden K, Mattsson S, Tejning S. X-ray fluorescence analysis of lead in human skeleton in vivo. ADVERTISEMENT: Supporters see fewer/no ads. (2011) ISBN:1609139437. Radiographs of the left knee in a 13-year-old girl about 1 year after she started treatment with denosumab. 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. Unable to process the form. 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. Kulshrestha M. Lead Poisoning Diagnosed by Abdominal X-Rays. [24]. [QxMD MEDLINE Link]. [Full Text]. 2. Scurvy in adults is rare. [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. sanding) or senescence (e.g. The syndrome is clinically characterized by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase levels, and late-onset spastic paraplegia. 26(3):479-81. Single transverse lines predominate, but multiple bands may be seen in cases of episodic lead poisoning. Robert Hoffman, Mary Ann Howland, Neal Lewin et al. Pediatrics. no financial relationships to ineligible companies to disclose. 56:1-16. Sachs HK. The other patient, the last patient of the series, was a 2.5-year-old (2019). Also, see eMedicineHealth's patient education article Poisoning. Poznanski AK. 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. 38 (3):575-585. Clinical disorders such as lead poisoning may arise from disrupted brain plasticity. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. Fortschr Rontgenstr. Plain abdominal radiograph in a 3-year-old patient shows multiple metallic particles due to ingested flakes of lead paint. (2016) ISBN: 9781844039104 -, 6. Lead poisoning or plumbismrefers to the multi-organ toxicity exerted by exposure to lead. Dense metaphyseal bands at the growth plates in long bones, epiphyseal ossification centers, anterior rib ends, sternum and spine were observed. 7. 8. Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine 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 2008 Jul-Aug. 659(1-2):166-75. 2016;9(10):1129-34. These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. At the time the article was created Owen Kang had no recorded disclosures. 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. This change was evidenced by increased A values and decreased E values and E/A ratios. Presenting features vary as a function of factors such as age (pediatric predisposition to more severe neurologic toxicity), ingested dose, and chronicity of exposure. Fortschr Neurol Psychiatr. Submitting a report will send us an email through our customer support system. Pediatr Radiol 50, 877878 (2020). Year Book Medical Pub. 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. Become a Gold Supporter and see no third-party ads. 1995 Dec. 8(4):281-8. If normal BLLs are maintained, the lead lines gradually decrease in density and disappear after about 4 years. [QxMD MEDLINE Link]. Such a childhood environment fosters exposure to biologically absorbable lead through the ingestion of dust contaminated with lead paint and water contaminated from lead pipe. Radiology. 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. AJR Am J Roentgenol. Benson and Price evaluated elderlypersons who grew up in a high-lead environment in Queensland, Australia, and experimental and neuropathologic studies demonstrated an association between exposure to lead and perivascular cerebellar calcification 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. Radiological Society of North America, Inc. 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. AJR Am J Roentgenol. Check for errors and try again. 4. 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. The presence of lead foreign bodies in the gastrointestinal tract may highlight the diagnosis and prompt immediate intervention. Tuzun M, Tuzun D, Salan A, Hekimoglu B. DeepDyve's default query mode: search by keyword or DOI. Dunnion, S., Paterson, A. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Pediatr Clin North Am. 2016. 2002 May-Jun. A workup was notable for nephrocalcinosis on imaging;. 2017 Mar. At the time the article was last revised Daniel J Bell had 2001. In 4 infants, lead lines were also seen in the axial skeleton. 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. [QxMD MEDLINE Link]. Radiology Review Manual. Lead toxicity and management of gunshot wounds in the lumbar spine. 2002 Jan. 23(1):25-41. 2016 Oct. 16 (5):494. Anne Paterson. However, prominent vertical trabecular formation may also represent normal anatomical variation in otherwise normal subjects. K-shell x-ray fluorescence (KXRF) techniques have been used in epidemiologic studies to establish rates of environmental lead exposure in high-risk communities. J Neurol Neurosurg Psychiatry. Also have triad of hypertrophic callus formation, dense metaphyseal bands, and ossification of the interosseus membranes of the forearm. Bookmark this article. Vet World. Case 4: bisphosphonate therapy - osteogenesis imperfecta, View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, Alternating lucent and dense metaphyseal bands. These images have been found to be reliable in young infants presenting with an unexplained encephalopathy. Initially, the brain develops more neurons and synaptic connections than are needed for function in later life. If high lead levels persist, growth deformity, such as . (1990) ISBN:0815176848. Aids to Radiological Differential Diagnosis. Pelkan .. AJR Am J Roentgenol. 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. Unable to process the form. Dense metaphyseal bands (differential). Bullets, ballistics, and mechanisms of injury. J Clin Endocrinol Metab 99:891897, Article 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). Fraenkel E. Untersuchungen ber die Mller--Barlowsche Krankheit. Biomed Environ Sci. [QxMD MEDLINE Link]. Mosby Inc. (1996) ISBN:0815187092. AJR Am J Roentgenol. [13] These lines, which are actually growth arrest lines, are not pathognomonic for lead poisoning (see the images below). [QxMD MEDLINE Link]. [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. [QxMD MEDLINE Link]. Benson MD, Price J. Cerebellar calcification and lead. 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.