Check for errors and try again. Lead exposure: health effects, prevention and treatment. Read and print from thousands of top scholarly journals. The skull and vertebral bodies appeared unaffected. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-10519. volume50,pages 877878 (2020)Cite this article. Curr Rev Musculoskelet Med 9:435444, Article Also, see eMedicineHealth's patient education article Poisoning. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . You can use Radiopaedia cases in a variety of ways to help you learn and teach. methotrexate Specht AJ, Weisskopf MG, Nie LH. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. Pediatr Clin North Am. Bone lead levels in an environmentally exposed elderly population in shanghai, China. Anton Sebastian. (1990) ISBN:0815176848. Dense sclerotic metaphyseal bands caused by denosumab therapy Pediatr Radiol. no financial relationships to ineligible companies to disclose. AJR Am J Roentgenol. Radiology. 2022. 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. May become dense bands after treatment Most often seen in distal femur, proximal tibia (around knee), proximal humerus, distal radius, ulna Imaging Findings Lucent transverse band in the metaphysis of rapidly growing bones Generally appear of uniform thickness across metaphysis Differential Diagnosis Lymphoma Patients at risk include elderly males, alcoholics, smokers and those with malabsorptive diseases. 1. At the time the article was created Jeremy Jones 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. A workup was notable for nephrocalcinosis on imaging;. 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. Raber, S. (1999). Initially, the brain develops more neurons and synaptic connections than are needed for function in later life. 2017 Mar. Ahlgren L, Liden K, Mattsson S, Tejning S. X-ray fluorescence analysis of lead in human skeleton in vivo. [13] These lines, which are actually growth arrest lines, are not pathognomonic for lead poisoning (see the images below). With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. Z. V. Maizlin. 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 [QxMD MEDLINE Link]. (adsbygoogle = window.adsbygoogle || []).push({}); Lucent Metaphyseal Bands in Leukemia. Aminat S. Ogun, Neena V. Joy, Menogh Valentine. 2023 DeepDyve, Inc. All rights reserved. Sachs HK. 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. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. 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. [17]. {"url":"/signup-modal-props.json?lang=us"}, Datir A, Carroll D, Bell D, et al. These bands are not pathognomonic, and the differential diagnosis for cases involving opaque metaphyseal lines is wide and includes poisoning with other heavy metals; hypervitaminosis D; and the healing stages of leukemia,rickets, andscurvy. steroids, radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32), 1. Evidence suggests that cerebellar calcification is a marker of previous lead intoxication. At the time the article was last revised Dijendra Nath Biswas had no recorded disclosures. [Full Text]. The symptoms of lead encephalopathy are mainly those associated with cerebral edema. Check for errors and try again. 2013 Nov. 22 (11):2353-7. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png. Johnston MV, Nishimura A, Harum K, et al. Mild flaring along metaphyseal corners was noted at distal femoral metaphysis suggestive of Pelkan spurs. https://doi.org/10.1007/s00247-020-04651-y, DOI: https://doi.org/10.1007/s00247-020-04651-y. https://doi.org/10.1007/s00247-020-04651-y. Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. 4. Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. 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 The patient also reported having experienced 3 short psychotic episodes. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. [QxMD MEDLINE Link]. {"url":"/signup-modal-props.json?lang=us"}, Khan I, Dense metaphyseal bands. Gunshot wounds: 1. [6]. 1990 Oct. 155 (4):685-90. The band migrates into the substance of bone at a rate that correlates with bone growth. The affected child was also deficient in linguistic skills and attention mechanisms. dense metaphyseal bands; cortex and flat bones may also be slightly dense Dense vertical striations about the metaphyses are less common than transverse bands and are found in a selected group of disorders. Specht AJ, Lin Y, Xu J, Weisskopf M, Nie LH. J Neurol Neurosurg Psychiatry. Piomelli S. Childhood lead poisoning. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. At the time the article was last revised David Carroll had In 4 infants, lead lines were also seen in the axial skeleton. These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. Eur Spine J. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. 2016. MMWR Recomm Rep. 2007 Nov 2. 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. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal Muscle Nerve. This patient was encephalopathic and anemic and had a lead level of 60 g/dL (2.898 mol/L) at admission. skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages. [QxMD MEDLINE Link]. [27]. Focal signs may predominate, mimicking a brain tumor in an area of generally diffuse brain edema. (2010) ISBN: 9781449976453 -. 2(2):82-6. 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. Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. Hollerman et al describe the substantial contribution radiologists can make to the evaluation and treatment of the patient with a gunshot wound. Anne Paterson. Google Scholar, Kobayashi E, Setsu N (2015) Osteosclerosis induced by denosumab. At the time the article was created Hani Makky Al Salam had no recorded disclosures. Plain radiography of the knee is an inexpensive and widely available investigation that may be rapidly performed. The child was advised to practice sports. 2018 Jun 1. The authors examined 2 male cousins who were living in the same household. Pediatr Radiol 50, 877878 (2020). His cousin, who was not exposed to lead, had normal neuropsychological function. ADVERTISEMENT: Supporters see fewer/no ads. Radiological Society of North America, Inc. http://www.deepdyve.com/lp/radiological-society-of-north-america-inc/the-dense-metaphyseal-band-sign1-T1YzHA6HGA. However, prominent vertical trabecular formation may also represent normal anatomical variation in otherwise normal subjects. Environmental sources may include 6: structural renovation (e.g. Biochemistry, Heme Synthesis. 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"}. 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. 1988 May. 2001 Jun. 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) [20]. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Vet World. Scurvy in adults is rare. Become a Gold Supporter and see no third-party ads. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Radiology Review Manual. [25], In another study, Trope et al concluded that lead has an effect on brain metabolites, as detected by MRS in vivo. 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. -. 54(2):271-94, viii. J Environ Biol. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. [Full Text]. link. 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 In healthy infants 3 years of age or younger, the finding of increased metaphyseal opacity is not unusual.

APPEARANCE

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 ). 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. Curr Osteoporos Rep 15:283292, Kurucu N, Akyuz C, Ergen FB et al (2018) Denosumab treatment in aneurysmal bone cyst: evaluation of nine cases. 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 . Lead-induced impairments in the neural processes related to working memory function. Anecdotal reports of angiography and ultrasonography used in the diagnosis of lead poisoninghave appeared in the literature. 1995 Dec. 8(4):281-8. Check for errors and try again. [QxMD MEDLINE Link]. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. 3. 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. Acta Paediatr. Usama Munir, MBBS, FRCS Orthopedic Surgeon, Department of Surgery, Whiston Hospital, UKDisclosure: Nothing to disclose. 2. Radiology. A normal skeletal radiograph does not rule out lead poisoning in children. 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 (. 1976 JUN. Bilateral, symmetrical, dense metaphyseal bands developtypically denser than the cortex of the adjacent metaphysis or diaphysis. Semantic Type: Finding Semantic ID: T033 Concept ID: C4020919 ID . Trope I, Lopez-Villegas D, Lenkinski RE. [24]. Pediatr Radiol. 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. Stephen Chapman, Richard Nakielny. 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. Am Fam Physician. Differential diagnosis Common chronic anemia, e.g. [QxMD MEDLINE Link]. 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. A Dictionary of the History of Medicine. 1998 Jun. Taybi H, Lachman RS. 1986 Feb. 146(2):267-70. The distal ulna is unremarkable. Mosby Inc. (1996) ISBN:0815187092. 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. X-ray fluorescence measurements of lead burden in subjects with low-levelcommunity lead exposure. Mennel EA, John SD. [QxMD MEDLINE Link]. AJR Am J Roentgenol. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Lead has been used extensively since ~7000 BCE 5. Become a Gold Supporter and see no third-party ads. 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. (2014) ISBN: 9780071801843 -. Pediatrics. They were placed on your computer when you launched this website. 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. 139(1):81-5. 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. Case 4: bisphosphonate therapy - osteogenesis imperfecta, View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, Alternating lucent and dense metaphyseal bands. no financial relationships to ineligible companies to disclose. Radiology Review Manual. 2002 Dec. 49(6):1285-304, vii. 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. 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. Child is a known case of thalassemia. [QxMD MEDLINE Link]. Findings occur more frequently in younger patients with open epiphyses. 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. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDEwMTEzLW92ZXJ2aWV3. At the time the case was submitted for publication Imran Ahmad Khan had no recorded disclosures. Case study, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-83195. Cellular and Molecular Toxicity of Lead in Bone. This website also contains material copyrighted by 3rd parties. Although in both children the MRI scans were normal, the lead-exposed boy had significant alterations in brain metabolites, with a reduced ratio of N -acetylaspartate to creatine in both gray matter and white matter. Include any more information that will help us locate the issue and fix it faster for you. Distinctive histology (irregular arrangement or mesh-like appearance of lamellae). Plumbism reinvented: childhood lead poisoning in France, 1985-1990. Sclerosis involved the anterior ribs, iliac crests, talus, and calcaneus. 7. Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. 2014. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-65973, View Dijendra Nath Biswas's current disclosures, see full revision history and disclosures, alternating lucent and dense metaphyseal bands. Flora SJ. 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. [QxMD MEDLINE Link]. The mechanisms of contamination include ingestion, inhalation, prenatal exposure, and dermal exposure, but the most common are ingestion and inhalation. Select data courtesy of the U.S. National Library of Medicine. No other abnormality was depicted on CT. [26]. Certain locations of missile fragments predispose the patient to lead poisoning or lead arthropathy. (2003) ISBN: 9780702026508 -, 5. Start a 14-Day Trial for You or Your Team. {"url":"/signup-modal-props.json?lang=us"}, Salam H, Deng F, Bell D, et al. Thalassemia is one of the known causes of dense metaphyseal bands. Clinical disorders such as lead poisoning may arise from disrupted brain plasticity. [from HPO] Term Hierarchy GTR MeSH CClinical test, RResearch test, OOMIM, GGeneReviews, VClinVar Pediatr Clin North Am. 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 The presence of lead foreign bodies in the gastrointestinal tract may highlight the diagnosis and prompt immediate intervention. Lead toxicity and management of gunshot wounds in the lumbar spine. Understanding how the brain's circuitry is sculpted during development provides an important perspective for thinking about neurodevelopmental disorders. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. At the time the article was created Abhi Datir had no recorded disclosures. Z Gesundh Wiss. The Roentgenogram in Early Scurvy. 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. [19], CT plays a minor role in the diagnosis of lead poisoning. Fassin D, Naud AJ. Dense metaphyseal bands (differential). Trope I, Lopez-Villegas D, Cecil KM, Lenkinski RE. Check for errors and try again. Primer of Diagnostic Imaging. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. You can change your cookie settings through your browser. 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. Mosby Inc. (1996) ISBN:0815187092. [QxMD MEDLINE Link]. 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. 8. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, El-Feky M, Fahrenhorst-Jones T, et al. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. [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.