ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. -. 4. Anton Sebastian. Vitamin C is essential for collagen synthesis, acting as a coenzyme to producing cross-linking of collagen fibers. The brother's lead levels were not elevated; an androgen receptor mutation identified on the X chromosome in both brothers confirmed the diagnosis of X-linked bulbospinomuscular atrophy. Bookmarks. [27]. High-resolution MRI and MRS were performed in both children by use of a 3-inch surface coil. Radiological Society of North America, Inc. http://www.deepdyve.com/lp/radiological-society-of-north-america-inc/the-dense-metaphyseal-band-sign1-T1YzHA6HGA. No other abnormality was depicted on CT. 37 (5):231-46. [QxMD MEDLINE Link]. Distal femoral epiphyses appeared centrally . 1975;51(601):765-9. 1990 Nov-Dec. 45(6):335-41. Piomelli S. Childhood lead poisoning. Select data courtesy of the U.S. National Library of Medicine. [1, 2, 3, 4, 5], Plain skeletal radiographs have been used extensively in the diagnosis of lead poisoning in children. J Comput Assist Tomogr. Physiol Meas. Benson MD, Price J. Cerebellar calcification and lead. At the time the article was created The Radswiki had no recorded disclosures. Fraenkel E. Untersuchungen ber die Mller--Barlowsche Krankheit. 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. Primer of Diagnostic Imaging. You can change your cookie settings through your browser. Gunshot wounds. A: Some of the common causes include chronic anemia, healing rickets and renal osteodystrophy. You can use Radiopaedia cases in a variety of ways to help you learn and teach. [25], In another study, Trope et al concluded that lead has an effect on brain metabolites, as detected by MRS in vivo. The patient had worked on refurbished houses, removing old paint, and complained of decreased cognition, fatigue, and muscle cramps. Hu H, Milder FL, Burger DE. Lead poisoning. This is a preview of subscription content, access via your institution. Check for errors and try again. Radiology. Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. Curr Rev Musculoskelet Med 9:435444, Article Dense transverse metaphyseal lines (mnemonic). 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. This may sometimes be pronounced and may lead to a false-positive diagnosis of lead intoxication. Lead exposure: health effects, prevention and treatment. The Roentgenogram in Early Scurvy. Check for errors and try again. Include any more information that will help us locate the issue and fix it faster for you. 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. 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) 2007 Apr. Pediatric Radiology Kulshrestha M. Lead Poisoning Diagnosed by Abdominal X-Rays. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. 1925;30(2):174. 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. Taybi H, Lachman RS. Read and print from thousands of top scholarly journals. Lead environmental pollution is a major health hazard throughout the world. AJR Am J Roentgenol. renal osteodystrophy; poisoning. A 40-year-old man with end-stage kidney disease and calcium oxalate nephrolithiasis presented to the emergency department with joint pain. In our group we saw thin sclerotic metaphyseal bands and overall increased . Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal 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. {"url":"/signup-modal-props.json?lang=us"}, Salam H, Deng F, 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. Seo J, Lee BK, Jin SU, Park JW, Kim YT, Ryeom HK, et al. 1976 JUN. Radiological Society of North America, Inc. {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. 56:1-16. dense metaphyseal bands (DMBs) in the proximal aspect of the rst metatarsals J Child Orthop (2008) 2:205-210 207 123. fractures of both proximal humeral metaphyses and Salter-Harris 2 fractures of the distal metacarpals. Thalassemia is one of the known causes of dense metaphyseal bands. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-21388. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. Part of Springer Nature. 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. 1. Unable to process the form. 1991 Oct. 59(10):413-24. 2021;:1-16. Unable to process the form. [from HPO] Term Hierarchy GTR MeSH CClinical test, RResearch test, OOMIM, GGeneReviews, VClinVar Unable to process the form. 2014. The Hand in Radiologic Diagnosis, With Gamuts and Pattern Profiles. Stanley Leonard Robbins, Vinay Kumar, Ramzi S. Cotran. Plain abdominal radiographs may also guide therapy in preventing further absorption through gastrointestinal decontamination. Goldfrank's Toxicologic Emergencies, Tenth Edition. Epub 2020 Mar 18. 2002 May-Jun. The lead lines may persist after the lead exposure ends. 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. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. 2002 Dec. 49(6):1285-304, vii. Environmental sources may include 6: structural renovation (e.g. 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. 1994 Apr. 9. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. J Toxicol Clin Toxicol. Thus, lead lines are most prominent at the knees; they can, however, also be seen in the wrist, in any other long bone metaphysis, in the axial skeleton, and in the margins of flat bones. Since Biemond and Van Creveld first described the condition in 1939, a total of 7 cases of lead encephalopathy with a clinical presentation of a cerebellar tumor have been reported. Pediatr Blood Cancer 65, Wang H, Boyce A, Tsai J et al (2014) Effects of denosumab treatment and discontinuation on human growth plates. It is soft, highly malleable, and ductile; it is a poor conductor of electricity. Wani AL, Ara A, Usmani JA. 1999 Apr. The term scurvy comes from various words used to describe the manifestations of the condition:covered with scabs, diseased, scorbutic. AJR Am J Roentgenol. The Secret Life of the Periodic Table. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures. This website also contains material copyrighted by 3rd parties. Check for errors and try again. (2003) ISBN: 9780702026508 -, 5. Lead is a bluish-white metal of bright luster. A radiograph of the knee showing dense metaphyseal bands strongly supports the diagnosis of lead poisoning. Findings occur more frequently in younger patients with open epiphyses. Sclerosis involved the anterior ribs, iliac crests, talus, and calcaneus. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dense Metaphyseal Bands and Lines. Pica. Plain abdominal radiographs may also guide therapy (eg, by allowing the prevention of further absorption through gastrointestinal decontamination). 2016. [QxMD MEDLINE Link]. 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. Plain abdominal radiograph in a 3-year-old patient shows multiple metallic particles due to ingested flakes of lead paint. Environ Health Perspect. In the study by Hu et al, 18 patients had bone lead levels below the measurement uncertainty. 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. The differential diagnosis of dense metaphyseal bands is wide. We'll do our best to fix them. Meyer PA, Brown MJ, Falk H. Global approach to reducing lead exposure and poisoning. Patients at risk include elderly males, alcoholics, smokers and those with malabsorptive diseases. These included striking rickets-like changes and marked osteopenia. Biochemical Data From Subject Aged 3 Days and 12 Months 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. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. Ingestion is more common in children, while the inhalation route is more frequent in occupationally exposed adults. Normal bone is laid down on the epiphyseal side of the lead line; with recovery, the lead line becomes broader and less dense and may eventually disappear. His cousin, a 9-year-old boy, had not been exposed to lead. MRI may demonstrate how the brain's functional maps undergo major reorganization in response to early environmental changes. Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Pediatr Radiol. Dense Metaphyseal Bands and Lines 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 The patient in the study by Schrote et al had a 25-year history of normochromic normocytic anemia with moderate basophilic stippling, mild renal failure, hyperuricemia, and abnormal porphyrins. Shubina O & Dudenkova N. The Effect of Lead on the Process of Spermatogenesis in Sex Glands of Male Albino Rats. Tax calculation will be finalised during checkout. Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. 8 (2): 55-64. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . Correspondence to 2. 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"}. A Dictionary of the History of Medicine. 626:96-98. Fortschr Rontgenstr. 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. [QxMD MEDLINE Link]. Biomed Environ Sci. Balani A, Golla N, Dey AK, Mahankali S, Seelam S. Image of the month: Intracranial calcifications due to chronic lead exposure. 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. Dense radiopaque bands of bone which are thicker than the adjacent diaphyseal cortex and may form at the metaphysis of growing bones. AD: IFITM5/BRIL: VI: Moderate to severe skeletal deformity. The decision was made at this time to commence treatment with pamidronate. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. His cousin, who was not exposed to lead, had normal neuropsychological function. Radiology. At the time the article was last revised Daniel J Bell had Lead has been used extensively since ~7000 BCE 5. sanding) or senescence (e.g. 1. Trope I, Lopez-Villegas D, Cecil KM, Lenkinski RE.
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