[QxMD MEDLINE Link]. Bone-within-bone appearance in the spine and ossification centers was identified on computed radiography in 36%. Alternating radiolucent and radiodense metaphyseal linescan be seen with a number of conditions and the differential diagnosis is wide: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Mild flaring along metaphyseal corners was noted at distal femoral metaphysis suggestive of Pelkan spurs. The causes of generalized increased bone density in pediatric patients can be divided according to a broad category of causes:. Sclerosis involved the anterior ribs, iliac crests, talus, and calcaneus. Unable to process the form. no financial relationships to ineligible companies to disclose. 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) 4. Case study, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-83195. [16] A portable x-ray fluorescence (XRF) device has been developed to overcome these disadvantages, but introduced a measurement dependency on soft tissue thickness. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Metaphyseal Bands - Syndrome Omim - RR School Of Nursing Plain abdominal radiographs may also guide therapy in preventing further absorption through gastrointestinal decontamination. The Roentgenogram in Early Scurvy. A normal skeletal radiograph does not rule out lead poisoning in children. Pediatr Radiol 50, 877878 (2020). 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 Dense Metaphyseal Bands and Lines Musculoskeletal. Anne Paterson. Clin Med (Lond). Specht AJ, Lin Y, Xu J, Weisskopf M, Nie LH. 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. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. 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. 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. 8 (2): 55-64. no financial relationships to ineligible companies to disclose. 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. The presence of lead foreign bodies in the gastrointestinal tract may highlight the diagnosis and prompt immediate intervention. Lead poisoning | Radiology Reference Article | Radiopaedia.org Learn more about Institutional subscriptions, Park H, Yang S, Sheppard W et al (2016) Current management of aneurysmal bone cysts. MMWR Recomm Rep. 2007 Nov 2. 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. At the time the article was created Jeremy Jones had no recorded disclosures. [QxMD MEDLINE Link]. AJR Am J Roentgenol. This patient was encephalopathic and anemic and had a lead level of 60 g/dL (2.898 mol/L) at admission. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . Plumbism reinvented: childhood lead poisoning in France, 1985-1990. Dr Ben Still. Taybi H, Lachman RS. 2. Check for errors and try again. 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. Pediatric Radiology For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Dense vertical striations about the metaphyses are less common than transverse bands and are found in a selected group of disorders. Lead is a bluish-white metal of bright luster. [QxMD MEDLINE Link]. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dense Metaphyseal Bands and Lines. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. The child was advised to practice sports. BLLs were normal. 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. J Toxicol Clin Toxicol. He had a depressed affect, postural tremor, right-arm weakness with partial denervation on electromyelography, and borderline-low sensory nerve action potential amplitudes. [27]. [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. OMD is a rare sclerosing bone disorder inherited in an autosomal recessive manner. Am J Public Health. At the time the case was submitted for publication Imran Ahmad Khan had no recorded disclosures. 1994 Apr. 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. PLoS One. Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage. Interpreting and managing blood lead levels < 10 microg/dL in children and reducing childhood exposures to lead: recommendations of CDC's Advisory Committee on Childhood Lead Poisoning Prevention. The lead lines may persist after the lead exposure ends. 9 (8):e105308. 1. [18] The investigators used a questionnaire to gather information about the participants' occupational and environmental lead exposure. [23]. Search 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 . A clinical diagnosis of transient synovitis was made. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. ADVERTISEMENT: Supporters see fewer/no ads. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. You can change your cookie settings through your browser. A bone-within-a-bone appearance has been described. 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. No other abnormality was depicted on CT. Biomarkers. The images showed thick sclerotic bands in the metaphyses around the knee joints, findings that were attributable to her denosumab chemotherapy. Mennel EA, John SD. J Comput Assist Tomogr. The presence of lead foreign bodies in the gastrointestinal tract (caused by pica) may highlight the diagnosis and prompt immediate intervention. The mechanisms of contamination include ingestion, inhalation, prenatal exposure, and dermal exposure, but the most common are ingestion and inhalation. Bilateral, symmetrical, dense metaphyseal bands developtypically denser than the cortex of the adjacent metaphysis or diaphysis. The decision was made at this time to commence treatment with pamidronate. Lead encephalopathy mimicking a cerebellar tumor. In infants with severe lead poisoning, the bands may be wide and may prevent normal remodeling. Hollerman et al describe the substantial contribution radiologists can make to the evaluation and treatment of the patient with a gunshot wound. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. J Environ Biol. 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. Dense transverse metaphyseal lines (mnemonic). 2002 May-Jun. [QxMD MEDLINE Link]. Young children undergoing CT or MRI may need heavy sedation or general anesthesia. Raber, S. (1999). 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. 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. periosteal reaction due to subperiosteal hemorrhage, scorbutic rosary: expansion of the costochondral junctions, may relate to the fracturing of the zone of provisional calcification during normal respiration, similar to the rachitic rosaryappearance as seen in rickets, Wimberger ring sign:circular, opaque radiologic shadow surrounding epiphyseal centers of ossification, which may result from bleeding, 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. The remainder had BLLs up to 21 mcg/g. Lead lines - The Lancet 2002 Jan. 23(1):25-41. 2007 Apr. In addition, T2-weighted MRI showed high signal intensity in the periventricular white matter, basal ganglia, insula, posterior thalamus, and pons. Dense metaphyseal bands (differential) - Radiopaedia In patients with chronic lead poisoning, opaque transverse metaphyseal bands appear in growing tubular bones. Skeletal Dysplasia Families: A Stepwise Approach to Diagnosis [7]. His cousin, a 9-year-old boy, had not been exposed to lead. 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. 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. Radiology Review Manual. Please confirm that you would like to log out of Medscape. Do not surround your terms in double-quotes ("") in this field. Pica. In our group we saw thin sclerotic metaphyseal bands and overall increased . Dense metaphyseal bands 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. 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. Start a 14-Day Trial for You or Your Team. Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. 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. [QxMD MEDLINE Link]. 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"}. 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. Lucent transverse metaphyseal lines (mnemonic) - Radiopaedia Bookmark this article. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 1975;51(601):765-9. Table 1. [Classification and Clinical Features of Osteogenesis StatPearls Publishing. Mosby Inc. (1996) ISBN:0815187092. Clinical disorders such as lead poisoning may arise from disrupted brain plasticity. Pediatr Radiol. [QxMD MEDLINE Link]. Skeletal features of primary hyperoxaluria type 1, revisited 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. [QxMD MEDLINE Link]. [22]. Read and print from thousands of top scholarly journals. AJR Am J Roentgenol. Lead environmental pollution is a major health hazard throughout the world. These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. If the lead exposure is prolonged, there may be lack of bone modeling. 2003 Jan. 33(1):11-4. View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, alternating radiolucent and radiodense metaphyseal lines. [17]. 2. Previous autopsy studies have shown that cerebellar calcification is more common in Queensland than elsewhere. At the time the article was last revised Mohammadtaghi Niknejad had 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. 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
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