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 (. 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. Lucent transverse metaphyseal lines (mnemonic). 2004;94 (11): 1854-63. Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. Am J Public Health. skybjugr (Old Norse): a swelling (bjugr) from drinking sour milk (skyr) on long sea voyages. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Blickman JG, Wilkinson RH, Graef JW. [QxMD MEDLINE Link]. Thanks for helping us catch any problems with articles on DeepDyve. The syndrome is clinically characterized by developmental delay of a progressive nature, hypotonia, elevated alkaline phosphatase levels, and late-onset spastic paraplegia. 1990 Oct. 155 (4):691-702. In the study by Hu et al, 18 patients had bone lead levels below the measurement uncertainty. PLoS One. Fortschr Neurol Psychiatr. 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]. (2011) ISBN:1609139437. Tax calculation will be finalised during checkout. [23]. lead. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. Pica. Q: Can you list some of the common causes for the above condition ? W B Saunders Co. (1984) ISBN:0721673171. Aids to Radiological Differential Diagnosis. 1999 Apr. A clinical diagnosis of transient synovitis was made. Unable to process the form. J Clin Endocrinol Metab 99:39543955, Department of Paediatric Radiology, Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast, BT, 12 6BE, UK, Department of Paediatric Oncology/Haematology, Royal Belfast Hospital for Sick Children, Belfast, UK, You can also search for this author in Focal signs may predominate, mimicking a brain tumor in an area of generally diffuse brain edema. The distal ulna is unremarkable. Vitamin C is essential for collagen synthesis, acting as a coenzyme to producing cross-linking of collagen fibers. Trope et al found that that magnetic resonance spectroscopy (MRS) may have a role as a noninvasive technique for the in vivo examination of the brain of children exposed to lead. If the lead exposure is prolonged, there may be lack of bone modeling. Also, see eMedicineHealth's patient education article Poisoning. 3. 2008 Jul-Aug. 659(1-2):166-75. 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. Two patients developed chronic renal disease and hypertension; in both, serum parathormone levels were elevated; serum calcium and phosphorus levels were normal in all 3. 1990 Oct. 155 (4):685-90. Dense sclerotic metaphyseal bands caused by denosumab therapy Pediatr Radiol. Stanley Leonard Robbins, Vinay Kumar, Ramzi S. Cotran. Shubina O & Dudenkova N. The Effect of Lead on the Process of Spermatogenesis in Sex Glands of Male Albino Rats. Bilateral, symmetrical, dense metaphyseal bands developtypically denser than the cortex of the adjacent metaphysis or diaphysis. volume50,pages 877878 (2020)Cite this article. Correspondence to A negative radiograph does not rule out lead poisoning in children. [13] These lines, which are actually growth arrest lines, are not pathognomonic for lead poisoning (see the images below). Piomelli S. Childhood lead poisoning. The band migrates into the substance of bone at a rate that correlates with bone growth. Biomed Environ Sci. Dense metaphyseal bands at the growth plates in long bones, epiphyseal ossification centers, anterior rib ends, sternum and spine were observed. The overall appearances were suggestive of lead poisoning. Sci Total Environ. Bone-within-bone appearance in the spine and ossification centers was identified on computed radiography in 36%. Manifestations differ based on a myriad of features including chronicity, exposure intensity, and age. The skull and vertebral bodies appeared unaffected. Had a bone marrow transplant recently. J Comput Assist Tomogr. Adv Pediatr. 10. -. 21 (4):347-52. ADVERTISEMENT: Supporters see fewer/no ads. 1998 Jun. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal Radiological Society of North America, Inc. http://www.deepdyve.com/lp/radiological-society-of-north-america-inc/the-dense-metaphyseal-band-sign1-T1YzHA6HGA. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. 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. J Trop Pediatr. https://doi.org/10.1007/s00247-020-04651-y. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Anne Paterson. 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. 3. Anecdotal reports of angiography and ultrasonography used in the diagnosis of lead poisoninghave appeared in the literature. Unable to process the form. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png. 56:1-16. 2. Unable to process the form. Hu H, Milder FL, Burger DE. Unable to process the form. Dense metaphyseal bands (differential) Last revised by Francis Deng on 29 Jan 2020 Edit article Citation, DOI, disclosures and article data The differential diagnosis of dense metaphyseal bands is wide. By excluding more serious causes, this finding was proved to be a normal variant. K-shell x-ray fluorescence (KXRF) techniques have been used in epidemiologic studies to establish rates of environmental lead exposure in high-risk communities. The presence of lead foreign bodies in the gastrointestinal tract may highlight the diagnosis and prompt immediate intervention. Scand J Work Environ Health. He had a depressed affect, postural tremor, right-arm weakness with partial denervation on electromyelography, and borderline-low sensory nerve action potential amplitudes. His cousin, who was not exposed to lead, had normal neuropsychological function. Theoretical modeling of a portable x-ray tube based KXRF system to measure lead in bone. link. 1988 May. Year Book Medical Pub. 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. Dr Ben Still. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. AJR Am J Roentgenol. Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. Balani A, Golla N, Dey AK, Mahankali S, Seelam S. Image of the month: Intracranial calcifications due to chronic lead exposure. Symmetric dense metaphyseal bands are noted in the lower end of femur and upper end of tibia and fibula. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, El-Feky M, Fahrenhorst-Jones T, et al. 7. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDEwMTEzLW92ZXJ2aWV3. Check for errors and try again. [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. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. [12] The patient presented with hypotonia, developmental delay, and complex seizures. Wani AL, Ara A, Usmani JA. At the time the article was last revised Mostafa El-Feky had Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Refer to the main article on differentials of dense metaphyseal bands. 1976 JUN. BLLs were normal. Become a Gold Supporter and see no third-party ads. Pediatrics. These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. 4B, C). 2016;9(10):1129-34. drug or hormone therapy in high dosage,e.g. Johnston MV, Nishimura A, Harum K, et al. Evidence suggests that cerebellar calcification is a marker of previous lead intoxication. Their results imply that MRS may depict metabolic abnormalities in individuals with lead poisoning. 2014. To save an article, log in first, or sign up for a DeepDyve account if you dont already have one. Arch Environ Health. All 3 patients had nonspecific neurologic symptoms of dementia, loss of visual acuity, peripheral neuropathy, syncope, dizziness, nystagmus, easy fatigue, or back pain. 1991 Oct. 59(10):413-24. The differential diagnosis of dense metaphyseal bands is wide. Plain abdominal radiographs may also guide therapy in preventing further absorption through gastrointestinal decontamination. 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. & Johnston, R. Dense sclerotic metaphyseal bands caused by denosumab therapy. 1903-4;7:231-265,291-310. In addition, the distal ends of the long bones may disappear and appear clubbed. Bernard D Coombs, MB, ChB, PhD Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New ZealandDisclosure: Nothing to disclose. Become a Gold Supporter and see no third-party ads. [20]. 1990 Nov-Dec. 45(6):335-41. Radiological Society of North America, Inc. Pediatr Radiol 50, 877878 (2020). Lead has been used extensively since ~7000 BCE 5. Radiology. [QxMD MEDLINE Link]. Dunnion, S., Paterson, A. Robbins and Cotran Pathologic Basis of Disease. 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. The causes of generalized increased bone density in pediatric patients can be divided according to a broad category of causes:. Become a Gold Supporter and see no third-party ads. The authors examined 2 male cousins who were living in the same household. These included striking rickets-like changes and marked osteopenia. 9 (8):e105308. [QxMD MEDLINE Link]. Check for errors and try again. Lead encephalopathy: CT and MR findings. Fraenkel E. Untersuchungen ber die Mller--Barlowsche Krankheit. Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). Primer of Diagnostic Imaging. [17]. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. The pellet was localized by means of 2-dimensional echocardiography of the left ventricular apical wall. X-ray fluorescence measurements of lead burden in subjects with low-levelcommunity lead exposure. 5. [8], With the advent of electrophysiology, it has become obvious that spinal cord involvement is the cause of lead neuropathy. Tutar HE, Atalay S, Uysalel A, et al. 7. (2010) ISBN: 9781449976453 -. 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. Osteosclerotic metaphyseal dysplasia: a skeletal dysplasia that may mimic lead poisoning in a child with hypotonia and seizures. Radiology Review Manual. 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. 2(2):82-6. Environmental sources may include 6: structural renovation (e.g. Dense vertical striations about the metaphyses are less common than transverse bands and are found in a selected group of disorders. Unable to process the form. Robert Hoffman, Mary Ann Howland, Neal Lewin et al. The evolution of the radiologic lead line. Pounds J, Long G, Rosen J. A mild anemia and elevated serum and urine lead levels supported a diagnosis of lead neuropathy. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. You can change your cookie settings through your browser. 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. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. Zou HJ, Ding Y, Huang KL, et al. 9. 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. The Effect of Lead on the Red Cell Membrane. (1990) ISBN:0815176848. Anton Sebastian. Ingestion is more common in children, while the inhalation route is more frequent in occupationally exposed adults. Lead poisoning. With chronic exposure to lead, patchy calcifications may be seen on MRI scans (though these are better seen on CT scans). 2013 Nov. 22 (11):2353-7. Subclinical lead exposure is associated with hyperuricemia. PubMedGoogle Scholar. Bullets, ballistics, and mechanisms of injury. 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. 1993 Apr. 2016 Oct. 16 (5):494. You are being redirected to sanding) or senescence (e.g. Trope I, Lopez-Villegas D, Lenkinski RE. 26(3):479-81. 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. 1925;30(2):174. {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. [QxMD MEDLINE Link]. 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. 2003 Jan. 33(1):11-4. 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 Woolf DA, Riach IC, Derweesh A, Vyas H. Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test. Lead environmental pollution is a major health hazard throughout the world. Dense radiopaque bands of bone which are thicker than the adjacent diaphyseal cortex and may form at the metaphysis of growing bones. Analysis of the metaphyseal bone changes should help distinguish OMD from lead poisoning and other causes of metaphyseal sclerosis. Unable to process the form. Submitting a report will send us an email through our customer support system. 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. At the time the article was created The Radswiki had no recorded disclosures. In addition, T2-weighted MRI showed high signal intensity in the periventricular white matter, basal ganglia, insula, posterior thalamus, and pons. no financial relationships to ineligible companies to disclose. 1986 Feb. 146(2):267-70. [18] The investigators used a questionnaire to gather information about the participants' occupational and environmental lead exposure. dense metaphyseal bands; cortex and flat bones may also be slightly dense (2003) ISBN: 9780702026508 -, 5. Because the patient was asymptomatic, left ventriculotomy was not used to extract the pellet; only pericardial tube drainage was carried out. For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Ralph Weissleder, Jack Wittenberg, Mukesh G. Harisinghani. Cellular and Molecular Toxicity of Lead in Bone. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. (1999) ISBN: 9781850700210 -, 6. {"url":"/signup-modal-props.json?lang=us"}, Jones J, Niknejad M, Qureshi P, et al. Physiol Meas. Read and print from thousands of top scholarly journals. 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. Table 1. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Deng F, et al. [27]. 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. Dense metaphyseal bands (differential). 11. The remainder had BLLs up to 21 mcg/g. 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. [QxMD MEDLINE Link]. 2. A: Some of the common causes include chronic anemia, healing rickets and renal osteodystrophy. At the time the article was created Hani Makky Al Salam had no recorded disclosures. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Clin Med (Lond).Dominguez High School Schedule, Articles D