Poznanski AK. Dense transverse metaphyseal lines (mnemonic). Lead poisoning. Plumbism reinvented: childhood lead poisoning in France, 1985-1990. J Toxicol Clin Toxicol. Plain radiography of the knee is an inexpensive and widely available investigation that may be rapidly performed. This may sometimes be pronounced and may lead to a false-positive diagnosis of lead intoxication. [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. 5. A Dictionary of the History of Medicine. 2008, Seen in up to 50% of patients with acute lymphoblastic leukemia, Believed to represent a disturbance of enchondral ossification, Most often seen in distal femur, proximal tibia (around knee), proximal humerus, distal radius, ulna, Lucent transverse band in the metaphysis of rapidly growing bones, Generally appear of uniform thickness across metaphysis, Congenital infections such as toxoplasmosis, rubella, cytomegalovirus, herpes and syphilis (TORCH infections), Any prior, severe, usually childhood illness. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. [QxMD MEDLINE Link]. Woolf DA, Riach IC, Derweesh A, Vyas H. Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test. [14] Plain skeletal radiography revealed opaque metaphyseal bands in all 15 infants; these were best seen around the knee joint. Pediatr Radiol 50, 877878 (2020). Radiology Review Manual. Caffeys Pediatric Diagnostic Imaging, 11th Ed. Primary Hyperoxaluria | NEJM Lead poisoning. 2021;:1-16. Ingestion is more common in children, while the inhalation route is more frequent in occupationally exposed adults. The overall appearances were suggestive of lead poisoning. Sign up today, get DeepDyve free for 14 days. Lead exposure: health effects, prevention and treatment. Omare M, Kibet J, Cherutoi J, Kengara F. A Review of Tobacco Abuse and Its Epidemiological Consequences. 3. sanding) or senescence (e.g. [27]. STORCH) A: anatomical variation M: metastatic neuroblastoma E: earlier systemic illness ( rickets, scurvy) L: leukemia, lymphoma LINING L: leukemia, lymphoma 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 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. steroids, radiation injury from bone-seeking isotopes (strontium-90, yttrium-90, phosphorus-32), 1. High-resolution MRI and MRS were performed in both children by use of a 3-inch surface coil. [QxMD MEDLINE Link]. Metaphyseal lesions and periosteal reaction of long bones in a child Neuroimaging is expensive and the availability may be limited. 139(1):81-5. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png. Dense metaphyseal bands Case contributed by Dr Imran Ahmad Khan Diagnosis certain Share Add to Citation, DOI & case data Presentation Severe knee pain. - 173.236.152.13. 2018 Jun 1. 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. Trope I, Lopez-Villegas D, Cecil KM, Lenkinski RE. Fassin D, Naud AJ. Scurvy in adults is rare. 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. AJR Am J Roentgenol. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. no financial relationships to ineligible companies to disclose. 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. A finding of disruption of brain plasticity, as seen on MRIs, is not a finding unique to lead intoxication. 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. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. 1952;68 (5): 709-24. Raber, S. (1999). Dense sclerotic metaphyseal bands caused by denosumab therapy Pediatr Radiol. 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. These metaphyseal bands, or lead lines, usually do not occur until blood lead levels (BLLs) reach 70-80 mcg/dL; they are not an early manifestation of lead intoxication. 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. Eur Spine J. 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 [QxMD MEDLINE Link]. Dhnert WF. 11. We have observed and described the evolution of the characteristic dense metaphyseal bands found in type V OI. (2003) ISBN: 0323023282 -, 2. A 40-year-old man with end-stage kidney disease and calcium oxalate nephrolithiasis presented to the emergency department with joint pain. View larger version: In this window In a new window Download as PowerPoint Slide Figure 2. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. 10. 9 (8):e105308. & Johnston, R. Dense sclerotic metaphyseal bands caused by denosumab therapy. 1980 Jul. 2013 Nov. 22 (11):2353-7. Johnston MV, Nishimura A, Harum K, et al. In addition, the distal ends of the long bones may disappear and appear clubbed. Pediatrics. 1. Acta Paediatr. 2. Certain locations of missile fragments predispose the patient to lead poisoning or lead arthropathy. Taybi H, Lachman RS. At the time the article was last revised Mohammadtaghi Niknejad had 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. Lead inhibits osteoclastic remodelling, but it has no effect on osteoblasts. Understanding how the brain's circuitry is sculpted during development provides an important perspective for thinking about neurodevelopmental disorders. Dunnion, S., Paterson, A. no financial relationships to ineligible companies to disclose. [QxMD MEDLINE Link]. In patients with chronic lead poisoning, opaque transverse metaphyseal bands appear in growing tubular bones. For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. J Trop Pediatr. Alternating radiolucent and radiodense metaphyseal lines. Flora SJ. 2016. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Require these words, in this exact order. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Table 1. [Classification and Clinical Features of Osteogenesis The remainder had BLLs up to 21 mcg/g. At the time the article was last revised Mostafa El-Feky had You are being redirected to 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. [22]. View Mohammadtaghi Niknejad's current disclosures, see full revision history and disclosures, alternating radiolucent and radiodense metaphyseal lines. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. If normal BLLs are maintained, the lead lines gradually decrease in density and disappear after about 4 years. Price excludes VAT (USA) 8. His cousin, a 9-year-old boy, had not been exposed to lead. [11] They described a 43-year-old man who was referred by a veterinary surgeon who evaluated the man's dog for a seizure; the veterinarian suspected a toxic lead exposure in both the dog and its owner. The skull and vertebral bodies appeared unaffected. StatPearls Publishing. pedi [Nick's Radiology Wiki] Zou et al studied the effects on systolic and diastolic cardiac function in 54 individuals exposed to lead and in 24 workers not exposed, and the Doppler echocardiographic results suggested that cardiac systolic function increased in the exposed group as a compensatory response to the effect of lead on myocardium. [12] The patient presented with hypotonia, developmental delay, and complex seizures. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Other clinical disorders, such as metabolic and epileptic encephalopathies and psychosocial deprivation, may be associated with disrupted brain plasticity. AJR Am J Roentgenol. Phenotypically indistinguishable from type IV OI. Mild flaring along metaphyseal corners was noted at distal femoral metaphysis suggestive of Pelkan spurs. [16] A portable x-ray fluorescence (XRF) device has been developed to overcome these disadvantages, but introduced a measurement dependency on soft tissue thickness. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-10519. 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. Do not surround your terms in double-quotes ("") in this field. 1999 Apr. Skeletal Dysplasia Families: A Stepwise Approach to Diagnosis 1990 Oct. 155 (4):685-90. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. Adv Pediatr. Woolf AD, Goldman R, Bellinger DC. Bullets, ballistics, and mechanisms of injury. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. Wani AL, Ara A, Usmani JA. 1993 Apr. 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. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal 1986 Feb. 146(2):267-70. Mosby Inc. (1996) ISBN:0815187092. Am J Roentgenol Radium Ther Nucl Med. Radiographic findings in congenital lead poisoning. Lippincott Williams & Wilkins. 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. 38 (3):575-585. 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. Update on the clinical management of childhood lead poisoning. [15] In addition, this modality has been utilized to identify health effects resulting from lead exposure, but the equipment is bulky and requires significant maintenance and licensing procedures. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. 2002 May-Jun. At the time the article was last revised Daniel J Bell had Anne Paterson. [1, 2, 3, 4, 5], Plain skeletal radiographs have been used extensively in the diagnosis of lead poisoning in children. 2001. The syndrome is clinically characterized by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase levels, and late-onset spastic paraplegia. Trope I, Lopez-Villegas D, Lenkinski RE. Differential Diagnosis. Lead poisoning. 1995 Dec. 8(4):281-8. Evolution of the radiographic appearance of the metaphyses - PubMed [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Dense transverse metaphyseal lines (mnemonic) - Radiopaedia Dense radiopaque bands of bone which are thicker than the adjacent diaphyseal cortex and may form at the metaphysis of growing bones. Skeletal imaging effects of pamidronate therapy in osteosarcoma They were asked to come for follow up in the clinic after 3 months. 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. 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. Tax calculation will be finalised during checkout. Goldfrank's Toxicologic Emergencies, Tenth Edition. 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 (. Seo J, Lee BK, Jin SU, Park JW, Kim YT, Ryeom HK, et al. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Hypovitaminosis C (scurvy). 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. Become a Gold Supporter and see no third-party ads. 2004;94 (11): 1854-63. 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]. Fortschr Rontgenstr. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. https://doi.org/10.1007/s00247-020-04651-y, DOI: https://doi.org/10.1007/s00247-020-04651-y. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. Analysis of the metaphyseal bone changes should help distinguish OMD from lead poisoning and other causes of metaphyseal sclerosis. Bone changes in hematologic disease. Shubina O & Dudenkova N. The Effect of Lead on the Process of Spermatogenesis in Sex Glands of Male Albino Rats. 107(6):1437-42. Follis RH, Park EA. Single transverse lines predominate, but multiple bands may be seen in cases of episodic lead poisoning. 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. 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. Dense metaphyseal bands | Radiology Case | Radiopaedia.org ADVERTISEMENT: Supporters see fewer/no ads. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, El-Feky M, Fahrenhorst-Jones T, et al. see full revision history and disclosures, https://www.ncbi.nlm.nih.gov/books/NBK537329/, 1. OMD is a rare sclerosing bone disorder inherited in an autosomal recessive manner. Arch Environ Health. [QxMD MEDLINE Link]. [25], In another study, Trope et al concluded that lead has an effect on brain metabolites, as detected by MRS in vivo. Physiol Meas. Anton Sebastian. (1990) ISBN:0815176848. Plain abdominal radiographs may also guide therapy in preventing further absorption through gastrointestinal decontamination. Environmental sources may include 6: structural renovation (e.g. Stanley Leonard Robbins, Vinay Kumar, Ramzi S. Cotran. 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. It is often seen in healthy children, especially after exposure to sunlight after winter. Dense sclerotic metaphyseal bands caused by denosumab therapy 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". At the time the article was created Owen Kang had no recorded disclosures. 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. 2023 DeepDyve, Inc. All rights reserved. (1999) ISBN: 9781850700210 -, 6. All DeepDyve websites use cookies to improve your online experience. Check for errors and try again. Both underwent a comprehensive neuropsychological evaluation. 50(4):337-40. 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 Part 4 Musculoskeletal Imaging | Radiology Key Selhi H & White J. Radiology Review Manual. [23]. 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]. 1998 Jun. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Q: Can you list some of the common causes for the above condition ? (1990) ISBN:0815176848. Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK 2014. Mennel and John reported a case of a 23-month-old boy with osteosclerotic metaphyseal dysplasia (OMD). Sources of occupational and recreational exposures include: automobile work (especially related to radiators). Lead lines - The Lancet 54(2):271-94, viii. Angiology. The patient had worked on refurbished houses, removing old paint, and complained of decreased cognition, fatigue, and muscle cramps. skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages. [26]. The decision was made at this time to commence treatment with pamidronate. In our group we saw thin sclerotic metaphyseal bands and overall increased . Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. Year Book Medical Pub. [QxMD MEDLINE Link]. Lead toxicity and management of gunshot wounds in the lumbar spine. Taybi H, Lachman RS. Radiographs revealed profound sclerosis of the metaphyses and epiphyses of the long and short bones in the extremities, with a unique pattern of distribution. 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. This increased metaphyseal opacity is a normal variant and represents exuberant calcification of the zone of provisional calcification. Males and females are equally affected. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. The causes of generalized increased bone density in pediatric patients can be divided according to a broad category of causes:. Pica. Reset filters. Functional MRI now offers the means to noninvasively study this plastic reorganization of the brain in children and adults. [QxMD MEDLINE Link]. Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. Refer to the main article on differentials of dense metaphyseal bands. {"url":"/signup-modal-props.json?lang=us"}, Jones J, Niknejad M, Qureshi P, et al. The Dense Metaphyseal Band Sign1, Radiology | DeepDyve ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 8 (2): 55-64. Hypovitaminosis C (scurvy) | Radiology Reference Article - Radiopaedia These bands were preceded and perhaps presaged by abnormalities of the metaphyses and growth plate that were present at birth. CLINICAL VIGNETTE JBMR - American Society for Bone and Mineral Research Curr Osteoporos Rep 15:283292, Kurucu N, Akyuz C, Ergen FB et al (2018) Denosumab treatment in aneurysmal bone cyst: evaluation of nine cases. {"url":"/signup-modal-props.json?lang=us"}, Datir A, Carroll D, Bell D, et al. Theoretical modeling of a portable x-ray tube based KXRF system to measure lead in bone. Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage. Opaque metaphyseal bands are also seen after poisoning with other heavy metals; with hypervitaminosis D; and during the healing stages of leukemia, rickets, and scurvy. Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. Pediatr Blood Cancer 65, Wang H, Boyce A, Tsai J et al (2014) Effects of denosumab treatment and discontinuation on human growth plates. A workup was notable for nephrocalcinosis on imaging;. 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. Check for errors and try again. More specifically, they found significant reductions in the levels of brain metabolites in gray matter but not white matter in individuals exposed to lead. Wonders of Radiology. Dense metaphyseal bands (differential) - Radiopaedia 3. Table 1. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dense Metaphyseal Bands and Lines. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. 3. AJR Am J Roentgenol. 1903-4;7:231-265,291-310. -. Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. [QxMD MEDLINE Link].