Check for errors and try again. Plain abdominal radiograph in a 3-year-old patient shows multiple metallic particles due to ingested flakes of lead paint. 2003 Jan. 33(1):11-4. Radiology Curr Osteoporos Rep 15:283292, Kurucu N, Akyuz C, Ergen FB et al (2018) Denosumab treatment in aneurysmal bone cyst: evaluation of nine cases. Johnston MV, Nishimura A, Harum K, et al. 4B, C). {"url":"/signup-modal-props.json?lang=us"}, Khan I, Dense metaphyseal bands. This increased metaphyseal opacity is a normal variant and represents exuberant calcification of the zone of provisional calcification. (2016) ISBN: 9781844039104 -, 6. [QxMD MEDLINE Link]. Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New ZealandDisclosure: Nothing to disclose. [14] Plain skeletal radiography revealed opaque metaphyseal bands in all 15 infants; these were best seen around the knee joint. Select data courtesy of the U.S. National Library of Medicine. 101(6):E7. 7. Osseous changes occurred on CT in 69% of patients, and on computed chest radiography in 53%. Physiol Meas. The skull and vertebral bodies appeared unaffected. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. CLINICAL VIGNETTE JBMR - American Society for Bone and Mineral Research Gunshot wounds: 2. (2010) ISBN: 9781449976453 -. 54(2):271-94, viii. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. 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. Dense sclerotic metaphyseal bands caused by denosumab therapy 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. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, El-Feky M, Fahrenhorst-Jones T, et al. Benson MD, Price J. Cerebellar calcification and lead. 1988 May. 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. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. Dense metaphyseal bands (differential). You can see your Bookmarks on your DeepDyve Library. Albers and Bromberg reported a case of X-linked bulbospinomuscular atrophy, or Kennedy disease, masquerading as lead neuropathy. 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 A bone-within-a-bone appearance has been described. 1998 Jun. The Hand in Radiologic Diagnosis, With Gamuts and Pattern Profiles. At the time the article was last revised Dijendra Nath Biswas had no recorded disclosures. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Radiological Society of North America, Inc. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Evidence suggests that cerebellar calcification is a marker of previous lead intoxication. AJR Am J Roentgenol. Acta Paediatr. Fassin D, Naud AJ. [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. Imaging: dense metaphyseal bands, suture separation due to lead encephalopathy (brain edema), dense ingested lead containing objects in GI tract Clinical: abdominal distension + pica Radiology Cases of Lead Poisoning [QxMD MEDLINE Link]. Bone changes in hematologic disease. Learn more about Institutional subscriptions, Park H, Yang S, Sheppard W et al (2016) Current management of aneurysmal bone cysts. Taybi H, Lachman RS. Lead toxicity and management of gunshot wounds in the lumbar spine. Mosby Inc. (1996) ISBN:0815187092. Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. Dense metaphyseal bands (Concept Id: C4020919) - National Center for [12] The patient presented with hypotonia, developmental delay, and complex seizures. This is a preview of subscription content, access via your institution. Dense metaphyseal bands at the growth plates in long bones, epiphyseal ossification centers, anterior rib ends, sternum and spine were observed. Please confirm that you would like to log out of Medscape. In select cases, abdominal radiographs may demonstrate lead-containing paint chips (resulting from pica) or other lead-containing objects. Some observations on bone growth, with particular respect to zones and transverse lines of increased density in the metaphysis. Mild flaring along metaphyseal corners was noted at distal femoral metaphysis suggestive of Pelkan spurs. Reassurance was given to the parents. [QxMD MEDLINE Link]. Become a Gold Supporter and see no third-party ads. Authors Shane Dunnion 1 , Anne Paterson 2 , Robert Johnston 3 Affiliations 1 Department of . 4. 2004;94 (11): 1854-63. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. At the time the article was created Mohammadtaghi Niknejad had no recorded disclosures. 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. Lead inhibits osteoclastic remodelling, but it has no effect on osteoblasts. The differential diagnosis for lucent transverse metaphyseal lines or bands may be recalled using various mnemonics: CAMEL LINING Mnemonics CAMEL C: congenital infection (e.g. Dense transverse metaphyseal lines (mnemonic). Lead poisoning. Unable to process the form. 1985 Aug. 48(8):814-8. J Clin Endocrinol Metab 99:891897, Article 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. Young children undergoing CT or MRI may need heavy sedation or general anesthesia. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. 2021;:1-16. 2. Hypovitaminosis C (scurvy) | Radiology Reference Article - Radiopaedia {"url":"/signup-modal-props.json?lang=us"}, Salam H, Deng F, Bell D, et al. 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. Check for errors and try again. Tax calculation will be finalised during checkout. no financial relationships to ineligible companies to disclose. [QxMD MEDLINE Link]. CAS Lead poisoning. Dense vertical striations about the metaphyses are less common than transverse bands and are found in a selected group of disorders. Eur Spine J. Unable to process the form. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dense Metaphyseal Bands and Lines. Alternating radiolucent and radiodense metaphyseal lines If you log out, you will be required to enter your username and password the next time you visit. AJR Am J Roentgenol. You are being redirected to 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. Check all that apply - Please note that only the first page is available if you have not selected a reading option after clicking "Read Article". ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. They were placed on your computer when you launched this website. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. 1990 Oct. 155 (4):685-90. 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. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Variable scleral . Radiology Review Manual. Presenting features vary as a function of factors such as age (pediatric predisposition to more severe neurologic toxicity), ingested dose, and chronicity of exposure. [19], CT plays a minor role in the diagnosis of lead poisoning. 50(4):337-40. Aids to Radiological Differential Diagnosis. Sachs HK. osteopetrosis; pyknodysostosis; metabolic. Lead lines - The Lancet Arch Pediatr Adolesc Med. 2002 Dec. 49(6):1285-304, vii. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. 8. Environ Health Perspect. Wani AL, Ara A, Usmani JA. Flora SJ. Sources of occupational and recreational exposures include: automobile work (especially related to radiators). [QxMD MEDLINE Link]. Neurologic toxicity and hematologic toxicity are common features. All DeepDyve websites use cookies to improve your online experience. In our group we saw thin sclerotic metaphyseal bands and overall increased . 26(3):479-81. Shubina O & Dudenkova N. The Effect of Lead on the Process of Spermatogenesis in Sex Glands of Male Albino Rats. If the lead exposure is prolonged, there may be lack of bone modeling. The decision was made at this time to commence treatment with pamidronate. Plain abdominal radiographs may also guide therapy (eg, by allowing the prevention of further absorption through gastrointestinal decontamination). Dense Metaphyseal Bands and Lines 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. Primary Hyperoxaluria | NEJM (2015) Interdisciplinary toxicology. The term scurvy comes from various words used to describe the manifestations of the condition:covered with scabs, diseased, scorbutic. 1990 Apr. no financial relationships to ineligible companies to disclose. Bookmark this article. ADVERTISEMENT: Supporters see fewer/no ads. Mutat Res. 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. 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. 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. Wonders of Radiology. In healthy infants 3 years of age or younger, the finding of increased metaphyseal opacity is not unusual. Kulshrestha M. Lead Poisoning Diagnosed by Abdominal X-Rays. Radiographic features of bisphosphonate therapy in pediatric - Springer Lead environmental pollution is a major health hazard throughout the world. Muscle Nerve. 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). show answer. Sign up today, get DeepDyve free for 14 days. Such a childhood environment fosters exposure to biologically absorbable lead through the ingestion of dust contaminated with lead paint and water contaminated from lead pipe. Check for errors and try again. 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. 36(2):90-3. Pediatrics. 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. Mennel EA, John SD. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. 1. A radiograph of the knee showing dense metaphyseal bands strongly supports the diagnosis of lead poisoning. Find any of these words, separated by spaces, Exclude each of these words, separated by spaces, Search for these terms only in the title of an article, Most effective as: LastName, First Name or Lastname, FN, Search for articles published in journals where these words are in the journal name, /lp/radiological-society-of-north-america-inc/the-dense-metaphyseal-band-sign1-T1YzHA6HGA, Raber, Scott A. Single transverse lines predominate, but multiple bands may be seen in cases of episodic lead poisoning. Patients at risk include elderly males, alcoholics, smokers and those with malabsorptive diseases. Environmental sources may include 6: structural renovation (e.g. This website also contains material copyrighted by 3rd parties. Year Book Medical Pub. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. Skeletal imaging effects of pamidronate therapy in osteosarcoma Alternating radiolucent and radiodense metaphyseal lines. Thanks for helping us catch any problems with articles on DeepDyve. Differential Diagnosis. Gunshot wounds. Hollerman et al describe the substantial contribution radiologists can make to the evaluation and treatment of the patient with a gunshot wound. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. Usama Munir, MBBS, FRCS Orthopedic Surgeon, Department of Surgery, Whiston Hospital, UKDisclosure: Nothing to disclose. Dense sclerotic metaphyseal bands caused by denosumab therapy - Springer The presence of lead foreign bodies in the gastrointestinal tract may highlight the diagnosis and prompt immediate intervention. [QxMD MEDLINE Link]. Clin Med (Lond). [from HPO] Term Hierarchy GTR MeSH CClinical test, RResearch test, OOMIM, GGeneReviews, VClinVar Findings occur more frequently in younger patients with open epiphyses. 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 Lucent transverse metaphyseal lines (mnemonic) - Radiopaedia Schroter C, Schroter H, Huffmann G. [Neurologic and psychiatric manifestations of lead poisoning in adults(case report and review of the literature)]. [QxMD MEDLINE Link]. (2011) ISBN:1609139437. We show the evolution of metaphyseal abnormalities from a rickets-like appearance to the classically described dense metaphyseal bands. 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. Title: Dense metaphyseal bands Definition: Dense radiopaque bands of bone which are thicker than the adjacent diaphyseal cortex and may form at the metaphysis of growing bones. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. Update on the clinical management of childhood lead poisoning. Stephen Chapman, Richard Nakielny. Lead has been used extensively since ~7000 BCE 5. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Pediatr Radiol 50, 877878 (2020). volume50,pages 877878 (2020)Cite this article. In addition, the distal ends of the long bones may disappear and appear clubbed. 82(4):423-5. Other clinical disorders, such as metabolic and epileptic encephalopathies and psychosocial deprivation, may be associated with disrupted brain plasticity. DeepDyve's default query mode: search by keyword or DOI. [16] A portable x-ray fluorescence (XRF) device has been developed to overcome these disadvantages, but introduced a measurement dependency on soft tissue thickness. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 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. Correspondence to You can use Radiopaedia cases in a variety of ways to help you learn and teach. Dr Ben Still. Ian Turnbull, MBChB, DMRD, FRCR Former Lecturer, Department of Radiology, University of Manchester Medical School; Former Consulting Neuroradiologist, Hope Hospital, Salford, Manchester and North Manchester General Hospital, UKDisclosure: Nothing to disclose. [QxMD MEDLINE Link]. 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. 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. Am J Roentgenol Radium Ther Nucl Med. drug or hormone therapy in high dosage,e.g. Hu H, Milder FL, Burger DE. [QxMD MEDLINE Link]. Curr Rev Musculoskelet Med 9:435444, Article Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). This change was evidenced by increased A values and decreased E values and E/A ratios. 1981 Apr. The evolution of the radiologic lead line. [26]. [22]. 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 . In patients with chronic lead poisoning, opaque transverse metaphyseal bands appear in growing tubular bones. Pediatr Clin North Am. Robert Hoffman, Mary Ann Howland, Neal Lewin et al. Read and print from thousands of top scholarly journals. 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 ). http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png. Include any more information that will help us locate the issue and fix it faster for you. Refer to the main article on differentials of dense metaphyseal bands. A finding of disruption of brain plasticity, as seen on MRIs, is not a finding unique to lead intoxication. At the time the article was created Hani Makky Al Salam had no recorded disclosures. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. 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. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Table 1. 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. 56:1-16. Become a Gold Supporter and see no third-party ads. Previous autopsy studies have shown that cerebellar calcification is more common in Queensland than elsewhere. All 3 patients had nonspecific neurologic symptoms of dementia, loss of visual acuity, peripheral neuropathy, syncope, dizziness, nystagmus, easy fatigue, or back pain. 3. 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. 2016 Oct. 16 (5):494. a, b Anteroposterior ( a) and lateral ( b) projections both demonstrate thick . In infants with severe lead poisoning, the bands may be wide and may prevent normal remodeling. Biochemistry, Heme Synthesis. 2023 Springer Nature Switzerland AG. Focal signs may predominate, mimicking a brain tumor in an area of generally diffuse brain edema. Piomelli S. Childhood lead poisoning. Require these words, in this exact order. [Full Text]. 2(2):82-6. Bone-within-bone appearance in the spine and ossification centers was identified on computed radiography in 36%. These patterns were found in the subcortical area, basal ganglia, vermis, and cerebellum. no financial relationships to ineligible companies to disclose. The Dense Metaphyseal Band Sign1, Radiology | DeepDyve The images showed thick sclerotic bands in the metaphyses around the knee joints, findings that were attributable to her denosumab chemotherapy. They were asked to come for follow up in the clinic after 3 months. The distal ulna is unremarkable. [24]. Share cases and questions with Physicians on Medscape consult. The child was advised to practice sports. Part of Springer Nature. Balani A, Golla N, Dey AK, Mahankali S, Seelam S. Image of the month: Intracranial calcifications due to chronic lead exposure. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. 2. Defective bone absorption can "wax and wane," leading to alternating dense and lucent metaphyseal bands and a bone-in-bone appearance. 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 A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. "Dense metaphyseal bands"[Clinical Features] OR 866573[uid] - MedGen Result 2002 Jan. 23(1):25-41. 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. Q: Can you list some of the common causes for the above condition ? Semantic Type: Finding Semantic ID: T033 Concept ID: C4020919 ID . At the time the article was created The Radswiki had no recorded disclosures. 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. [QxMD MEDLINE Link]. Become a Gold Supporter and see no third-party ads. If high lead levels persist, growth deformity, such as . Manifestations differ based on a myriad of features including chronicity, exposure intensity, and age. 1986 Feb. 146(2):267-70. X-ray fluorescence measurements of lead burden in subjects with low-levelcommunity lead exposure.
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