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. Hu H, Milder FL, Burger DE. Share cases and questions with Physicians on Medscape consult. Plumbism reinvented: childhood lead poisoning in France, 1985-1990. Ingestion is more common in children, while the inhalation route is more frequent in occupationally exposed adults. Lead poisoning. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Check for errors and try again. 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 Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). Bookmark this article. Opaque metaphyseal bands in the lower femur, upper tibia, and the upper fibula secondary to lead poisoning in a child. Check for errors and try again. 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]. Tuzun M, Tuzun D, Salan A, Hekimoglu B. 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. Lead poisoning or plumbismrefers to the multi-organ toxicity exerted by exposure to lead. Piomelli S. Childhood lead poisoning. 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. ADVERTISEMENT: Supporters see fewer/no ads. Lead poisoning | Radiology Reference Article | Radiopaedia.org Pediatr Radiol 50, 877878 (2020). 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 sclerotic metaphyseal bands caused by denosumab therapy Dense metaphyseal bands (Concept Id: C4020919) - National Center for 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. 1. Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage. Unable to process the form. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-8549. At the time the article was created Abhi Datir had no recorded disclosures. [18] The investigators used a questionnaire to gather information about the participants' occupational and environmental lead exposure. [20]. 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. A radiograph of the knee showing dense metaphyseal bands strongly supports the diagnosis of lead poisoning. Eur Spine J. Dense Metaphyseal Bands and Lines | STATdx Aminat S. Ogun, Neena V. Joy, Menogh Valentine. 2002 Jan. 23(1):25-41. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Hollerman JJ. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. 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. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. Fortschr Rontgenstr. Biomed Environ Sci. His cousin, who was not exposed to lead, had normal neuropsychological function. A workup was notable for nephrocalcinosis on imaging;. 8. {"url":"/signup-modal-props.json?lang=us"}, Khan I, Dense metaphyseal bands. Single transverse lines predominate, but multiple bands may be seen in cases of episodic lead poisoning. Sign up today, get DeepDyve free for 14 days. 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. Infantile scurvy, historically also known as Barlow disease, is named after Sir Thomas Barlow (1845-1945), Professor of Medicine at University College London 1895-1907 5. Also have triad of hypertrophic callus formation, dense metaphyseal bands, and ossification of the interosseus membranes of the forearm. These patterns were found in the subcortical area, basal ganglia, vermis, and cerebellum. [QxMD MEDLINE Link]. 54(2):271-94, viii. Become a Gold Supporter and see no third-party ads. Lead encephalopathy mimicking a cerebellar tumor. Zou HJ, Ding Y, Huang KL, et al. 2023 Springer Nature Switzerland AG. Postgrad Med J. The Dense Metaphyseal Band Sign1, Radiology | DeepDyve Lead exposure: health effects, prevention and treatment. Sculpting the developing brain. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. In select cases, abdominal radiographs may demonstrate lead-containing paint chips (resulting from pica) or other lead-containing objects. Findings occur more frequently in younger patients with open epiphyses. [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. Evolution of the radiographic appearance of the metaphyses - PubMed Check for errors and try again. sanding) or senescence (e.g. Shubina O & Dudenkova N. The Effect of Lead on the Process of Spermatogenesis in Sex Glands of Male Albino Rats. Phenotypically indistinguishable from type IV OI. Unable to process the form. Dense transverse metaphyseal lines (mnemonic). Part of Springer Nature. Read and print from thousands of top scholarly journals. Environmental sources may include 6: structural renovation (e.g. AJR Am J Roentgenol. Skeletal features of primary hyperoxaluria type 1, revisited [QxMD MEDLINE Link]. 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. 82(4):423-5. 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. 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. Lead is a bluish-white metal of bright luster. Bullets, ballistics, and mechanisms of injury. Lead encephalopathy: CT and MR findings. A 40-year-old man with end-stage kidney disease and calcium oxalate nephrolithiasis presented to the emergency department with joint pain. Anton Sebastian. [QxMD MEDLINE Link]. Dense Metaphyseal Bands and Lines At admission, the patients were found to have increased serum lead levels (54-72 mcg/dL; normal range, 0-30 mcg/dL). The presence of lead foreign bodies in the gastrointestinal tract (caused by pica) may highlight the diagnosis and prompt immediate intervention. This change was evidenced by increased A values and decreased E values and E/A ratios. Pearl M, Boxt LM. It is often seen in healthy children, especially after exposure to sunlight after winter. 4. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. [QxMD MEDLINE Link]. 2018 Jun 1. methotrexate Q: Can you list some of the common causes for the above condition ? Had a bone marrow transplant recently. Hypovitaminosis C (scurvy). [QxMD MEDLINE Link]. High-resolution MRI and MRS were performed in both children by use of a 3-inch surface coil. ADVERTISEMENT: Supporters see fewer/no ads. StatPearls Publishing. Skeletal imaging effects of pamidronate therapy in osteosarcoma Analysis of the metaphyseal bone changes should help distinguish OMD from lead poisoning and other causes of metaphyseal sclerosis. Radiology Review Manual. Stephen Chapman, Richard Nakielny. The pellet was localized by means of 2-dimensional echocardiography of the left ventricular apical wall. 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. Neurologic toxicity and hematologic toxicity are common features. 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. no financial relationships to ineligible companies to disclose. 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 2001. If you log out, you will be required to enter your username and password the next time you visit. 1.
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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 ). Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. Copy and paste the desired citation format or use the link below to download a file formatted for EndNote. 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). Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. [QxMD MEDLINE Link]. 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. 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. Include any more information that will help us locate the issue and fix it faster for you. J Neurol Neurosurg Psychiatry. (1990) ISBN:0815176848. The syndrome is clinically characterized by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase levels, and late-onset spastic paraplegia. 10. [26]. 26(3):479-81. 1986 Feb. 146(2):267-70. Primer of Diagnostic Imaging. Semantic Type: Finding Semantic ID: T033 Concept ID: C4020919 ID . [9, 10]. Skeletal imaging effects of pamidronate therapy in - PubMed J Clin Endocrinol Metab 99:891897, Article 8 (2): 55-64. The overall appearances were suggestive of lead poisoning. Price excludes VAT (USA) Case 4: bisphosphonate therapy - osteogenesis imperfecta, View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, Alternating lucent and dense metaphyseal bands. Lead-induced impairments in the neural processes related to working memory function. Sachs HK. "The Dense Metaphyseal Band Sign1.". 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 no financial relationships to ineligible companies to disclose. Scurvy is a condition caused by a dietary lack of vitamin C (ascorbic acid), hence is also called hypovitaminosis C, and is characterized by an increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing. 139(1):81-5. A normal skeletal radiograph does not rule out lead poisoning in children. Part 4 Musculoskeletal Imaging | Radiology Key A: Some of the common causes include chronic anemia, healing rickets and renal osteodystrophy. [Full Text]. Gunshot wounds: 2. AD: IFITM5/BRIL: VI: Moderate to severe skeletal deformity. [13] These lines, which are actually growth arrest lines, are not pathognomonic for lead poisoning (see the images below). 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. Lead poisoning. 48:1-38. The evolution of the radiologic lead line. Clinical disorders such as lead poisoning may arise from disrupted brain plasticity. Usama Munir, MBBS, FRCS Orthopedic Surgeon, Department of Surgery, Whiston Hospital, UKDisclosure: Nothing to disclose. In infants with severe lead poisoning, the bands may be wide and may prevent normal remodeling. https://doi.org/10.1007/s00247-020-04651-y, DOI: https://doi.org/10.1007/s00247-020-04651-y. Selhi H & White J. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. 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 Lead environmental pollution is a major health hazard throughout the world. Lead poisoning. View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, alternating radiolucent and radiodense metaphyseal lines. Symmetric dense metaphyseal bands are noted in the lower end of femur and upper end of tibia and fibula. Anne Paterson. 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. [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. 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. Osseous changes occurred on CT in 69% of patients, and on computed chest radiography in 53%. Anteroposterior radiograph of the wrist obtained in a 2-year-old boy reveals a dense metaphyseal band (arrow) in the distal radius, without flaring or cupping. 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. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. 2013 Nov. 22 (11):2353-7. Table 1. [Classification and Clinical Features of Osteogenesis Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. 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. With chronic exposure to lead, patchy calcifications may be seen on MRI scans (though these are better seen on CT scans). Follis RH, Park EA. Woolf AD, Goldman R, Bellinger DC. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Sclerosis involved the anterior ribs, iliac crests, talus, and calcaneus. The decision was made at this time to commence treatment with pamidronate. Exposure to lead appears to selectively alter metabolism of cortical gray matter. Pediatr Clin North Am. Radiology Review Manual. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Dense sclerotic metaphyseal bands caused by denosumab therapy Pediatr Radiol. Disturbance of enchondral bone formation can produce lucent metaphyseal bands (red arrows are oval) as in this patient with leukemia. 7. Seo J, Lee BK, Jin SU, Park JW, Kim YT, Ryeom HK, et al. 3. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. 1991 Oct. 59(10):413-24. Distinctive histology (irregular arrangement or mesh-like appearance of lamellae). At the time the article was last revised Mohammadtaghi Niknejad had Goldfrank's Toxicologic Emergencies, Tenth Edition. Anecdotal reports of angiography and ultrasonography used in the diagnosis of lead poisoninghave appeared in the literature. They were placed on your computer when you launched this website. 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 Epub 2020 Mar 18. 2014. [27]. A clinical diagnosis of transient synovitis was made. Patients at risk include elderly males, alcoholics, smokers and those with malabsorptive diseases. Dense metaphyseal bands at the growth plates in long bones, epiphyseal ossification centers, anterior rib ends, sternum and spine were observed. 1990 Oct. 155 (4):691-702. 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. You can see your Bookmarks on your DeepDyve Library. To get new article updates from a journal on your personalized homepage, please log in first, or sign up for a DeepDyve account if you dont already have one. Radiology These included striking rickets-like changes and marked osteopenia. For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. CLINICAL VIGNETTE JBMR - American Society for Bone and Mineral Research Plain radiography of the knee is an inexpensive and widely available investigation that may be rapidly performed. Robbins and Cotran Pathologic Basis of Disease.Shooting In Riverview, Fl Today,
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