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For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Wonders of Radiology. Fassin D, Naud AJ. Gunshot wounds: 1. At the time the article was created Abhi Datir had no recorded disclosures. Dense metaphyseal bands (differential). All DeepDyve websites use cookies to improve your online experience. This change was evidenced by increased A values and decreased E values and E/A ratios. At admission, the patients were found to have increased serum lead levels (54-72 mcg/dL; normal range, 0-30 mcg/dL). Sign up today, get DeepDyve free for 14 days. 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]. The common occurrence of renal impairment in these patients may be the result of associated lead nephropathy. The decrease in diastolic cardiac function was more significant in the lead-intoxication group than in the nonexposed group. 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. Opaque metaphyseal bands in the upper and lower tibia and the upper fibula secondary to lead poisoning in a child. (2016) ISBN: 9781844039104 -, 6. Variable scleral . Their results imply that MRS may depict metabolic abnormalities in individuals with lead poisoning. Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. The patient had worked on refurbished houses, removing old paint, and complained of decreased cognition, fatigue, and muscle cramps. 1985 Aug. 48(8):814-8. Both underwent a comprehensive neuropsychological evaluation. Check for errors and try again. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. 3. Radiological Society of North America, Inc. Price excludes VAT (USA) We show the evolution of metaphyseal abnormalities from a rickets-like appearance to the classically described dense metaphyseal bands. 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. 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. Mutat Res. Become a Gold Supporter and see no third-party ads. By excluding more serious causes, this finding was proved to be a normal variant. 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. 5. 21 (4):347-52. 2018 Jun 1. (2003) ISBN: 9780702026508 -, 5. (2019). 8. Pediatr Clin North Am. 2002 May-Jun. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. [QxMD MEDLINE Link]. Albers and Bromberg reported a case of X-linked bulbospinomuscular atrophy, or Kennedy disease, masquerading as lead neuropathy. In addition, the distal ends of the long bones may disappear and appear clubbed. 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. We have observed and described the evolution of the characteristic dense metaphyseal bands found in type V OI. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. no financial relationships to ineligible companies to disclose. Rentfrow B, Vaidya R, Elia C, Sethi A. Semantic Type: Finding Semantic ID: T033 Concept ID: C4020919 ID . Check for errors and try again. 2(2):82-6. The evolution of the radiologic lead line. [12] The patient presented with hypotonia, developmental delay, and complex seizures. Hollerman et al describe the substantial contribution radiologists can make to the evaluation and treatment of the patient with a gunshot wound. Lippincott Williams & Wilkins. 17(4):419-23. Epub 2020 Mar 18. Osseous changes occurred on CT in 69% of patients, and on computed chest radiography in 53%. PubMedGoogle Scholar. Mosby Inc. (1996) ISBN:0815187092. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. He had a depressed affect, postural tremor, right-arm weakness with partial denervation on electromyelography, and borderline-low sensory nerve action potential amplitudes. Fig. Perelman et al reported a case in which MRI results excluded a focal mass, and early treatment of edema prevented neurosurgical exploration. Submitting a report will send us an email through our customer support system. The differential diagnosis of dense metaphyseal bands is wide. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. Evidence suggests that cerebellar calcification is a marker of previous lead intoxication. They were placed on your computer when you launched this website. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. 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) Unable to process the form. In children, the density and width of the lead bands are well correlated with the concentration of lead ingestion or inhalation, as well as with the duration of lead exposure. Require these words, in this exact order. The decision was made at this time to commence treatment with pamidronate. 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 undergoing CT or MRI may need heavy sedation or general anesthesia. Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New ZealandDisclosure: Nothing to disclose. 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. Check for errors and try again. The band migrates into the substance of bone at a rate that correlates with bone growth. 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., DOI: At the time the article was created Owen Kang had no recorded disclosures. [QxMD MEDLINE Link]. Radiology Review Manual. 54(2):271-94, viii. 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. Frankel line: dense zone of provisional calcification Trmmerfeld zone: lucent metaphyseal band underlying Frankel line Pelkin spur: metaphyseal spurs that result in cupping of the metaphysis Pelkin fracture: metaphyseal corner fracture Adults osteopenia pathological fractures W B Saunders Co. (1984) ISBN:0721673171. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal 2007 Apr. [QxMD MEDLINE Link]. Blickman JG, Wilkinson RH, Graef JW. No other abnormality was depicted on CT. Child is a known case of thalassemia. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Pediatrics. You can see your Bookmarks on your DeepDyve Library. 2001 Jun. Bilateral, symmetrical, dense metaphyseal bands developtypically denser than the cortex of the adjacent metaphysis or diaphysis. Part of Springer Nature. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Deng F, et al. Bone-within-bone appearance in the spine and ossification centers was identified on computed radiography in 36%. [QxMD MEDLINE Link]. 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. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. Become a Gold Supporter and see no third-party ads. 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. Musculoskeletal. Sculpting the developing brain. Woolf AD, Goldman R, Bellinger DC. Had a bone marrow transplant recently. Balani A, Golla N, Dey AK, Mahankali S, Seelam S. Image of the month: Intracranial calcifications due to chronic lead exposure. If normal BLLs are maintained, the lead lines gradually decrease in density and disappear after about 4 years. -. Seo J, Lee BK, Jin SU, Park JW, Kim YT, Ryeom HK, et al. drug or hormone therapy in high dosage,e.g. 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. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. STORCH) A: anatomical variation M: metastatic neuroblastoma E: earlier systemic illness ( rickets, scurvy) L: leukemia, lymphoma LINING L: leukemia, lymphoma (2011) ISBN:1609139437. AD: IFITM5/BRIL: VI: Moderate to severe skeletal deformity. Previous Section Next Section


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 (. [QxMD MEDLINE Link]. Johnston MV, Nishimura A, Harum K, et al. 1976 JUN. Year Book Medical Pub. Unable to process the form. 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. 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. bleeding gums, petechiae), and impaired wound healing. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. Reference article, (Accessed on 02 May 2023) {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. The other patient, the last patient of the series, was a 2.5-year-old 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. 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. MRI may demonstrate how the brain's functional maps undergo major reorganization in response to early environmental changes. 1998 Jun. Zou HJ, Ding Y, Huang KL, et al. (2010) ISBN: 9781437707922 -, 3. {"url":"/signup-modal-props.json?lang=us"}, Datir A, Carroll D, Bell D, et al. 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 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. Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. These abnormalities suggest that the underlying defect in type V OI may involve a molecule common to both bone and cartilage that is involved in the regulation of growth plate development and metadiaphyseal . J Toxicol Clin Toxicol. Select data courtesy of the U.S. National Library of Medicine. Specht AJ, Lin Y, Xu J, Weisskopf M, Nie LH. [1, 2, 3, 4, 5], Plain skeletal radiographs have been used extensively in the diagnosis of lead poisoning in children. [QxMD MEDLINE Link]. At the time the article was last revised David Carroll had At the time the article was created Jeremy Jones had no recorded disclosures. 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. Plumbism reinvented: childhood lead poisoning in France, 1985-1990. 2002 Jan. 23(1):25-41. 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). The mechanisms of contamination include ingestion, inhalation, prenatal exposure, and dermal exposure, but the most common are ingestion and inhalation. Presenting features vary as a function of factors such as age (pediatric predisposition to more severe neurologic toxicity), ingested dose, and chronicity of exposure. [Full Text]. 10. In 4 infants, lead lines were also seen in the axial skeleton. Become a Gold Supporter and see no third-party ads. 1981 Apr. Radiology Review Manual. Schroter C, Schroter H, Huffmann G. [Neurologic and psychiatric manifestations of lead poisoning in adults(case report and review of the literature)]. Males and females are equally affected. 1990 Oct. 155 (4):691-702. 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. Biochemistry, Heme Synthesis. [8], With the advent of electrophysiology, it has become obvious that spinal cord involvement is the cause of lead neuropathy. 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. Pediatr Radiol 50, 877878 (2020). 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. sickle cell disease , thalassemia chemotherapy, e.g. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders.


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 ). - A: Some of the common causes include chronic anemia, healing rickets and renal osteodystrophy. [27]. 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. 4. 48:1-38. Bookmark this article. You can change your cookie settings through your browser. The term scurvy comes from various words used to describe the manifestations of the condition:covered with scabs, diseased, scorbutic. Am Fam Physician. As with CT, MRI plays a minor role in the diagnosis of lead poisoning. no financial relationships to ineligible companies to disclose. Bullets, ballistics, and mechanisms of injury. 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. osteopetrosis; pyknodysostosis; metabolic. J Environ Biol. Unable to process the form. Q: Can you list some of the common causes for the above condition ? J Clin Endocrinol Metab 99:891897, Article [24]. Analysis of the metaphyseal bone changes should help distinguish OMD from lead poisoning and other causes of metaphyseal sclerosis. This patient was encephalopathic and anemic and had a lead level of 60 g/dL (2.898 mol/L) at admission. Lead poisoning. Hu H, Milder FL, Burger DE. Share cases and questions with Physicians on Medscape consult. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. 36(2):90-3. To subscribe to email alerts, please log in first, or sign up for a DeepDyve account if you dont already have one. [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. 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. how much lead was in leaded gasoline,

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