Phenotypically indistinguishable from type IV OI. 1. 21 (4):347-52. Metaphyseal lesions and periosteal reaction of long bones in a child Lead poisoning or plumbismrefers to the multi-organ toxicity exerted by exposure to lead. (2014) ISBN: 9780071801843 -. 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. & Johnston, R. Dense sclerotic metaphyseal bands caused by denosumab therapy. ADVERTISEMENT: Supporters see fewer/no ads. Reset filters. 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 Lead Poisoning | Pediatric Radiology Reference Article | Pediatric 4. 2021;:1-16. MRI may demonstrate how the brain's functional maps undergo major reorganization in response to early environmental changes. To save an article, log in first, or sign up for a DeepDyve account if you dont already have one. Thalassemia is one of the known causes of dense metaphyseal bands. At the time the article was created Mohammadtaghi Niknejad had no recorded disclosures. 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. Scurvy in adults is rare. StatPearls Publishing. Q: Can you list some of the common causes for the above condition ? Blickman JG, Wilkinson RH, Graef JW. Dense transverse metaphyseal lines (mnemonic) - Radiopaedia Check for errors and try again. Specht AJ, Lin Y, Weisskopf M, Yan C, Hu H, Xu J, et al. The child was advised to practice sports. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. 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. 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. Scand J Work Environ Health. 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. Lead encephalopathy mimicking a cerebellar tumor. Pediatrics. 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. 2018 Jun 1. 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. ADVERTISEMENT: Supporters see fewer/no ads. 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 Hand in Radiologic Diagnosis, With Gamuts and Pattern Profiles. Copy and paste the desired citation format or use the link below to download a file formatted for EndNote. Scurvy is a condition caused by a dietary lack of vitamin C (ascorbic acid), hence is also called hypovitaminosis C, and is characterized by an increased bleeding tendency and impaired collagen synthesis resulting in osteoporosis and impaired wound healing. Poznanski AK. {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. 2016. Perelman S, Hertz-Pannier L, Hassan M, Bourrillon A. 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. BLLs were normal. Males and females are equally affected. Lead poisoning. 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. The Secret Life of the Periodic Table. Lead resists corrosion; in fact, lead pipes bearing the insignia of Roman emperors that were used as drains from the baths are still in service. The band migrates into the substance of bone at a rate that correlates with bone growth. At the time the article was last revised Francis Deng had no recorded disclosures. The overall appearances were suggestive of lead poisoning. [17]. Lead-induced impairments in the neural processes related to working memory function. Aminat S. Ogun, Neena V. Joy, Menogh Valentine. Check for errors and try again. Z. V. Maizlin. Tax calculation will be finalised during checkout. Woolf AD, Goldman R, Bellinger DC. Neurologic toxicity and hematologic toxicity are common features. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Google Scholar, Kobayashi E, Setsu N (2015) Osteosclerosis induced by denosumab. Check for errors and try again. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. 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 Patients may present with lethargy and malaise, bone pain, bleeding diathesis (e.g. 2017 Mar. Unable to process the form. no financial relationships to ineligible companies to disclose. Refer to the main article on differentials of dense metaphyseal bands. A mild anemia and elevated serum and urine lead levels supported a diagnosis of lead neuropathy. no financial relationships to ineligible companies to disclose. 2002 Jan. 23(1):25-41. At the time the article was created Jeremy Jones had no recorded disclosures. This website also contains material copyrighted by 3rd parties. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. 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". In addition, the distal ends of the long bones may disappear and appear clubbed. 1980 Jul. 1993 Apr. 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 2002 Dec. 49(6):1285-304, vii. dense metaphyseal bands; cortex and flat bones may also be slightly dense Radiology Lippincott Williams & Wilkins. In patients with chronic lead poisoning, opaque transverse metaphyseal bands appear in growing tubular bones. [QxMD MEDLINE Link]. Check for errors and try again. Physiol Meas. 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). Osseous changes occurred on CT in 69% of patients, and on computed chest radiography in 53%. Environmental sources may include 6: structural renovation (e.g. (2019). [24]. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. Beverly P Wood, MD, MSEd, PhD Professor Emerita of Radiology and Pediatrics, Division of Medical Education, Keck School of Medicine, University of Southern California; Professor of Radiology, Loma Linda University School of Medicine 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. Manifestations differ based on a myriad of features including chronicity, exposure intensity, and age. At the time the article was last revised Daniel J Bell had Sign up today, get DeepDyve free for 14 days. Also have triad of hypertrophic callus formation, dense metaphyseal bands, and ossification of the interosseus membranes of the forearm. [QxMD MEDLINE Link]. 1903-4;7:231-265,291-310. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-8549. 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. Benson MD, Price J. Cerebellar calcification and lead. 1991;91:17-32. sanding) or senescence (e.g. Curr Rev Musculoskelet Med 9:435444, Article It does not occur before six months of age because maternal stores are maintained until then. Skeletal imaging effects of pamidronate therapy in - PubMed 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. Fortschr Rontgenstr. 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. Cellular and Molecular Toxicity of Lead in Bone. 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. Defective bone absorption can "wax and wane," leading to alternating dense and lucent metaphyseal bands and a bone-in-bone appearance. 1996;34(1):107-8. 3. 1925;30(2):174. Radiological Society of North America, Inc. Pediatr Clin North Am. A clinical diagnosis of transient synovitis was made. Dense sclerotic metaphyseal bands caused by denosumab therapy - Springer Sculpting the developing brain. 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. the dense metaphyseal bands and generalized osteopenia persisted, and there was clear progression of the calcification of the interosseous membrane of the forearm (Fig. Young children undergoing CT or MRI may need heavy sedation or general anesthesia. 54(2):271-94, viii. 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. Schroter C, Schroter H, Huffmann G. [Neurologic and psychiatric manifestations of lead poisoning in adults(case report and review of the literature)]. [20]. 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. Albers JW, Bromberg MB. The pellet was localized by means of 2-dimensional echocardiography of the left ventricular apical wall. The decrease in diastolic cardiac function was more significant in the lead-intoxication group than in the nonexposed group. 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. Thanks for helping us catch any problems with articles on DeepDyve. You can change your cookie settings through your browser. The patient also reported having experienced 3 short psychotic episodes. Update on the clinical management of childhood lead poisoning. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. View larger version: In this window In a new window Download as PowerPoint Slide Figure 1. Select data courtesy of the U.S. National Library of Medicine. Zou HJ, Ding Y, Huang KL, et al. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. Although no distinctive neurologic syndrome could be demonstrated, the incidence of hypertension and hyperuricemia was increased in the affected patients, and serum creatinine levels were increased. This increased metaphyseal opacity is a normal variant and represents exuberant calcification of the zone of provisional calcification. 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 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. Primer of Diagnostic Imaging. These images have been found to be reliable in young infants presenting with an unexplained encephalopathy. Hollerman JJ. Ralph Weissleder, Jack Wittenberg, Mukesh G. Harisinghani. A negative radiograph does not rule out lead poisoning in children. 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. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Deng F, et al. [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. Sci Total Environ. Pelkan .. The Effect of Lead on the Red Cell Membrane. 1. J Clin Endocrinol Metab 99:891897, Article Now presented with severe knee pain. Unable to process the form. Bookmarks. STORCH) A: anatomical variation M: metastatic neuroblastoma E: earlier systemic illness ( rickets, scurvy) L: leukemia, lymphoma LINING L: leukemia, lymphoma Flora SJ. OMD is a rare sclerosing bone disorder inherited in an autosomal recessive manner. Hypovitaminosis C (scurvy). Radiology. Differential Diagnosis. Clinical manifestations vary, ranging from mild (or asymptomatic) cases to a severe life-threatening encephalopathy 6. (1999) ISBN: 9781850700210 -, 6. PubMedGoogle Scholar. Effects of lead on systolic and diastolic cardiac functions. 139(1):81-5. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. The Roentgenogram in Early Scurvy. Curr Osteoporos Rep 15:283292, Kurucu N, Akyuz C, Ergen FB et al (2018) Denosumab treatment in aneurysmal bone cyst: evaluation of nine cases. 1990 Oct. 155 (4):691-702. 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. Search and discover articles on DeepDyve, PubMed, and Google Scholar, Organize articles with folders and bookmarks, Collaborate on and share articles and folders. 2. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Fortschr Neurol Psychiatr. Theoretical modeling of a portable x-ray tube based KXRF system to measure lead in bone. Ingestion is more common in children, while the inhalation route is more frequent in occupationally exposed adults. Evolution of the radiographic appearance of the metaphyses over the Lead has been used extensively since ~7000 BCE 5. Biochemical Data From Subject Aged 3 Days and 12 Months At the time the article was last revised Mostafa El-Feky had dense metaphyseal bands: differential and mnemonic lucent metaphyseal bands Electrochemical CO2 reduction to C2+ products using Cu-based electrocatalysts: A review Touqeer Ahmad et al., Nano Research Energy, 2022 Photo-enhanced rechargeable high-energy-density metal batteries for solar energy conversion and storage Eur Spine J. The differential diagnosis for lucent transverse metaphyseal lines or bandsmay be recalled using various mnemonics: Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. The Dense Metaphyseal Band Sign1, Radiology | DeepDyve Lancet 385:539, Hoyer-Kuhn H, Semler O, Schoenau E (2014) Effect of denosumab on the growing skeleton in osteogenesis imperfecta. [QxMD MEDLINE Link]. Selhi H & White J. Differential diagnosis Common chronic anemia, e.g. 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. ADVERTISEMENT: Supporters see fewer/no ads. At the time the article was created Hani Makky Al Salam had no recorded disclosures. [QxMD MEDLINE Link]. These bands were preceded and perhaps presaged by abnormalities of the metaphyses and growth plate that were present at birth. 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. Pearl M, Boxt LM. The patient had worked on refurbished houses, removing old paint, and complained of decreased cognition, fatigue, and muscle cramps. [QxMD MEDLINE Link]. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. 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. 1990 Apr. [14] Plain skeletal radiography revealed opaque metaphyseal bands in all 15 infants; these were best seen around the knee joint. Alternating radiolucent and radiodense metaphyseal lines. In addition, the serum activity of the MB isoenzymes of creatine phosphokinase (CPK-MB), one of the indices of myocardial damage, was significantly higher in the exposed group than that in control subjects; a positive correlation was found between CPK-MB activity and Pb-B. We'll do our best to fix them. Year Book Medical Pub. AJR Am J Roentgenol. In our group we saw thin sclerotic metaphyseal bands and overall increased . 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. At the time the article was last revised David Carroll had A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. 626:96-98. [23]. 2001. Hu H, Milder FL, Burger DE. PLoS One. (1990) ISBN:0815176848. The decision was made at this time to commence treatment with pamidronate. 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. In addition, T2-weighted MRI showed high signal intensity in the periventricular white matter, basal ganglia, insula, posterior thalamus, and pons. milder pediatric cases may manifest with disturbances in behavior, growth, hearing and cognition, severe pediatric cases may progress to encephalopathy with seizures, coma, ataxia, cerebral edema, adults may similarly demonstrate mild (tired, irritable) symptoms or a severe encephalopathy, peripheral motor neuropathy may also develop, elevations (chronic) in zinc and erythrocyte protoporphyrin, may impair spermatic function and spermatogenesis, bone remodeling and growth may be affected in pediatric cases, with proposed mechanisms including 10, alterations in circulating endocrine factors such as parathyroid hormone and activated vitamin D, derangement in paracrine signaling factors such as osteocalcin, direct cellular toxicity, particularly affecting osteoclasts, growth trajectory and height may be affected, pathologically increased deposition of calcium in the zones of provisional calcification responsible for the dense metaphyseal bands on radiographs referred to as "lead lines", including aminolevulinic acid dehydratase and ferrochelatase 9, may impair production of erythropoeitin 6, erythrocyte functional and structural derangements, inhibition of erythrocyte sodium-potassium pump 8, predisposing to breakdown of the cell membrane and hemolysis, residual nucleotide clumps in cytosol appear as basophilic stippling, 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, abdominal radiographs utile for identification of exposure source and anatomic location if an ingestion is suspected 7, intra-luminal radio-opaque foreign body (or multiple punctate densities), serial radiographs may be used to monitor effectiveness of bowel decontamination, identification of source crucial to prevent ongoing toxicity 6, decontamination of ongoing sources of enteral absorption (paint chips, foreign bodies), some patients may require chelating agents to enhance elimination, also known as "British anti-Lewisite" or BAL, also known as succimer, the favored available oral chelating agent over d-penicillamine.