Aids to Radiological Differential Diagnosis. Metaphyseal lesions and periosteal reaction of long bones in a child Sign up today, get DeepDyve free for 14 days. Usama Munir, MBBS, FRCS Orthopedic Surgeon, Department of Surgery, Whiston Hospital, UKDisclosure: Nothing to disclose. It does not occur before six months of age because maternal stores are maintained until then. osteopetrosis; pyknodysostosis; metabolic. 1986 Feb. 146(2):267-70. 2002 Dec. 49(6):1285-304, vii. Magnetic resonance imaging and spectroscopy of regional brain structure in a 10-year-old boy with elevated blood lead levels. Google Scholar, Kobayashi E, Setsu N (2015) Osteosclerosis induced by denosumab. 8. Skeletal Dysplasia Families: A Stepwise Approach to Diagnosis [QxMD MEDLINE Link]. XRF-measured bone lead (Pb) as a biomarker for Pb exposure and toxicity among children diagnosed with Pb poisoning. {"url":"/signup-modal-props.json?lang=us"}, Niknejad M, Bell D, Deng F, et al. Radiology. 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. Phenotypically indistinguishable from type IV OI. 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 bleeding gums, petechiae), and impaired wound healing. Lead poisoning. 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. pedi [Nick's Radiology Wiki] However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. [QxMD MEDLINE Link]. Refer to the main article on differentials of dense metaphyseal bands. The symptoms of lead encephalopathy are mainly those associated with cerebral edema. In healthy infants 3 years of age or younger, the finding of increased metaphyseal opacity is not unusual. Defective collagen cross-linking compromises skin, joint, bone, and vascular integrity. Pediatrics. Check for errors and try again. Semantic Type: Finding Semantic ID: T033 Concept ID: C4020919 ID . With chronic exposure to lead, patchy calcifications may be seen on MRI scans (though these are better seen on CT scans). Become a Gold Supporter and see no third-party ads. 82(4):423-5. Wonders of Radiology. no financial relationships to ineligible companies to disclose. Copy and paste the desired citation format or use the link below to download a file formatted for EndNote. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in [12] The patient presented with hypotonia, developmental delay, and complex seizures. Several mental retardation syndromes and cognitive disorders have been recognized as being secondary to genetic disruption of intracellular signaling cascades. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. Plain abdominal radiographs may also guide therapy (eg, by allowing the prevention of further absorption through gastrointestinal decontamination). Manifestations differ based on a myriad of features including chronicity, exposure intensity, and age. (2010) ISBN: 9781437707922 -, 3. 2013 Nov. 22 (11):2353-7. 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 ). The remainder had BLLs up to 21 mcg/g. Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. These bands were preceded and perhaps presaged by abnormalities of the metaphyses and growth plate that were present at birth. Dr Ben Still. Neuropsychological evaluation in the 2 cousins demonstrated areas of impairment in the lead-exposed child; these included difficulties in the academic skills of reading, writing, and arithmetic. Neurologic toxicity and hematologic toxicity are common features. This change was evidenced by increased A values and decreased E values and E/A ratios. Functional MRI now offers the means to noninvasively study this plastic reorganization of the brain in children and adults. ADVERTISEMENT: Supporters see fewer/no ads. [26]. A workup was notable for nephrocalcinosis on imaging; dense, metaphyseal bands on radiography of the hands; and calcium deposition in the cornea and skin. Opaque metaphyseal bands in the lower femur, upper tibia, and the upper fibula secondary to lead poisoning in a child. They revealed dense metaphyseal bands at both distal femoral physes with adjacent proximal horizontal bands of radiolucency suggestive of zone of provisional calcification with Trummerfeld zones. Clinical manifestations vary, ranging from mild (or asymptomatic) cases to a severe life-threatening encephalopathy 6. J Toxicol Clin Toxicol. 2021;:1-16. 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. Unable to process the form. methotrexate https://doi.org/10.1007/s00247-020-04651-y. Lead poisoning. 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). Hollerman JJ, Fackler ML, Coldwell DM, Ben-Menachem Y. 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. These images have been found to be reliable in young infants presenting with an unexplained encephalopathy. 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. We show the evolution of metaphyseal abnormalities from a rickets-like appearance to the classically described dense metaphyseal bands. Year Book Medical Pub. Radiographic findings in congenital lead poisoning. Blickman JG, Wilkinson RH, Graef JW. 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. 56:1-16. {"url":"/signup-modal-props.json?lang=us"}, Jones J, Niknejad M, Qureshi P, et al. Unable to process the form. Lead poisoning or plumbismrefers to the multi-organ toxicity exerted by exposure to lead. J Comput Assist Tomogr. Dunnion, S., Paterson, A. Become a Gold Supporter and see no third-party ads. The distal ulna is unremarkable. They were asked to come for follow up in the clinic after 3 months. Young children and older persons are predisposed to scurvy due to their diet or the overheating of food. The radiologic "lead band" revisited. 1. The Secret Life of the Periodic Table. They appear on radiographs as bone that is more radiopaque that the adjacent diaphyseal cortex. However, prominent vertical trabecular formation may also represent normal anatomical variation in otherwise normal subjects. 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. 1952;68 (5): 709-24. AD: IFITM5/BRIL: VI: Moderate to severe skeletal deformity. Woolf AD, Goldman R, Bellinger DC. 48:1-38. Epub 2020 Mar 18. The patient also reported having experienced 3 short psychotic episodes. Become a Gold Supporter and see no third-party ads. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A. Intracranial calcification in adults with chronic lead exposure. At the time the article was created Abhi Datir had no recorded disclosures. 2008 Jul-Aug. 659(1-2):166-75. Radiology of syndromes, metabolic disorders, and skeletal dysplasias. no financial relationships to ineligible companies to disclose. 1988 May. Flora SJ. The lead lines may persist after the lead exposure ends. 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. 2022. We'll do our best to fix them. A negative radiograph does not rule out lead poisoning in children. Price excludes VAT (USA) Hypovitaminosis C (scurvy). All 3 patients had nonspecific neurologic symptoms of dementia, loss of visual acuity, peripheral neuropathy, syncope, dizziness, nystagmus, easy fatigue, or back pain. - 173.236.152.13. 2001 Jun. Subclinical lead exposure is associated with hyperuricemia. 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. Eur Spine J. Some observations on bone growth, with particular respect to zones and transverse lines of increased density in the metaphysis. 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. Albers JW, Bromberg MB. volume50,pages 877878 (2020)Cite this article. [25], In another study, Trope et al concluded that lead has an effect on brain metabolites, as detected by MRS in vivo. This may sometimes be pronounced and may lead to a false-positive diagnosis of lead intoxication. 1980 Jul. Dense metaphyseal bands Case contributed by Dr Imran Ahmad Khan Diagnosis certain Share Add to Citation, DOI & case data Presentation Severe knee pain. Reference article, Radiopaedia.org (Accessed on 02 May 2023) https://doi.org/10.53347/rID-10519. If normal BLLs are maintained, the lead lines gradually decrease in density and disappear after about 4 years. 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. Evolution of the radiographic appearance of the metaphyses - PubMed 1991 Oct. 59(10):413-24. In addition, T2-weighted MRI showed high signal intensity in the periventricular white matter, basal ganglia, insula, posterior thalamus, and pons. 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. 1990 Oct. 155 (4):691-702. Perelman S, Hertz-Pannier L, Hassan M, Bourrillon A. Curr Osteoporos Rep 15:283292, Kurucu N, Akyuz C, Ergen FB et al (2018) Denosumab treatment in aneurysmal bone cyst: evaluation of nine cases. X-linked bulbospinomuscular atrophy (Kennedy''s disease) masquerading as lead neuropathy. 1996;34(1):107-8. [QxMD MEDLINE Link]. 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. Ingestion is more common in children, while the inhalation route is more frequent in occupationally exposed adults. AJR Am J Roentgenol. Dense Metaphyseal Bands and Lines | STATdx Rentfrow B, Vaidya R, Elia C, Sethi A. Radiology Search Also, see eMedicineHealth's patient education article Poisoning. Primer of Diagnostic Imaging. Table 1. Am J Roentgenol Radium Ther Nucl Med. 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 626:96-98. 1995 Dec. 8(4):281-8. Gunshot wounds. [Full Text]. 1903-4;7:231-265,291-310. [QxMD MEDLINE Link]. All DeepDyve websites use cookies to improve your online experience. 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 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. 1990 Nov-Dec. 45(6):335-41. 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. [QxMD MEDLINE Link]. https://doi.org/10.1007/s00247-020-04651-y, DOI: https://doi.org/10.1007/s00247-020-04651-y. The skull and vertebral bodies appeared unaffected. Skeletal imaging effects of pamidronate therapy in - PubMed The evolution of the radiologic lead line. Distinctive histology (irregular arrangement or mesh-like appearance of lamellae). [19], CT plays a minor role in the diagnosis of lead poisoning. 136(1):83-4. Johnston MV, Nishimura A, Harum K, et al. Generalized increased bone density in children | Radiology Reference Pelkan .. Dhnert WF. 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 ). Common sources of exposure to this ubiquitous metal may be broadly classified as occupational (or recreational), environmental, or perinatal (primarily trans-placental). 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 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. Perelman et al reported a case in which MRI results excluded a focal mass, and early treatment of edema prevented neurosurgical exploration. A clinical diagnosis of transient synovitis was made. 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. Lead encephalopathy mimicking a cerebellar tumor. Also have triad of hypertrophic callus formation, dense metaphyseal bands, and ossification of the interosseus membranes of the forearm. 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. [QxMD MEDLINE Link]. Pediatr Radiol. [QxMD MEDLINE Link]. Sources of occupational and recreational exposures include: automobile work (especially related to radiators). [24]. Radiology. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Dense Metaphyseal Bands and Lines. [14] Plain skeletal radiography revealed opaque metaphyseal bands in all 15 infants; these were best seen around the knee joint. Skeletal features of primary hyperoxaluria type 1, revisited 2023 DeepDyve, Inc. All rights reserved. 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. see full revision history and disclosures, https://www.ncbi.nlm.nih.gov/books/NBK537329/, 1. A workup was notable for nephrocalcinosis on imaging;. Patient Data Age: 11 years Gender: Female Symmetric dense metaphyseal bands x_ray Frontal Lateral Lateral X-ray Frontal 50(4):337-40. Muscle Nerve. Taybi H, Lachman RS. X-ray fluorescence measurements of lead burden in subjects with low-levelcommunity lead exposure. [Full Text]. Fortschr Rontgenstr. 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"}. Ralph Weissleder, Jack Wittenberg, Mukesh G. Harisinghani. 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 a, b Anteroposterior ( a) and lateral ( b) projections both demonstrate thick . Dense metaphyseal bands (differential) - Radiopaedia Lead Poisoning | Pediatric Radiology Reference Article | Pediatric Lead encephalopathy: CT and MR findings. [1, 2, 3, 4, 5], Plain skeletal radiographs have been used extensively in the diagnosis of lead poisoning in children. [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. Other significant manifestations in both children and adults arise from the propensity for bleeding, including intra-articular, retrobulbar, and intracranial hemorrhage. These excess neurologic units are "sculpted" away during early brain development before the mature brain finally develops. K-shell x-ray fluorescence (KXRF) techniques have been used in epidemiologic studies to establish rates of environmental lead exposure in high-risk communities. 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. Trope I, Lopez-Villegas D, Lenkinski RE. At the time the article was last revised Francis Deng had no recorded disclosures. 2. 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. {"url":"/signup-modal-props.json?lang=us"}, Kang O, Biswas D, Deng F, et al. Hu H, Milder FL, Burger DE. In patients with chronic lead poisoning, opaque transverse metaphyseal bands appear in growing tubular bones. Fraenkel E. Untersuchungen ber die Mller--Barlowsche Krankheit. Radiological Society of North America, Inc. drug or hormone therapy in high dosage,e.g. PLoS One. Reset filters. 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. 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. Lead toxicity: a review. Google Scholar, Boyce A (2017) Denosumab: an emerging therapy in pediatric bone disorders. The Hand in Radiologic Diagnosis, With Gamuts and Pattern Profiles. [QxMD MEDLINE Link]. 5. [28] A slightly elevated blood lead level (BLL) of the patient was alarming because of the possibility of subsequent lead poisoning associated with retained pellets. Lead-induced impairments in the neural processes related to working memory function. Lead inhibits osteoclastic remodelling, but it has no effect on osteoblasts. Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. More specifically, they found significant reductions in the levels of brain metabolites in gray matter but not white matter in individuals exposed to lead. 4. In children, the density and width of the lead bands are well correlated with the concentration of lead ingestion or inhalation, as well as with the duration of lead exposure. Dense sclerotic metaphyseal bands caused by denosumab therapy Pediatr Radiol. [QxMD MEDLINE Link]. Initially, the brain develops more neurons and synaptic connections than are needed for function in later life. 3. [7], Reyes et al described the CT findings of cerebral and cerebellar calcification in 3 adults with known exposure to lead of 30 years or longer, and on imaging, they found that the patterns of calcification varied and were punctiform, curvilinear, specklike, or diffuse. 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. sickle cell disease , thalassemia chemotherapy, e.g. Reassurance was given to the parents. With chronic exposure to lead, patchy calcifications may be seen on CT scans in adults. 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. 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. Silverman FN, Kuhn JP, Caffey J. Essentials of Caffey's pediatric X-ray diagnosis. Dense transverse metaphyseal lines (mnemonic) - Radiopaedia Previous autopsy studies have shown that cerebellar calcification is more common in Queensland than elsewhere. Zou HJ, Ding Y, Huang KL, et al. The developing brain is subject to major changes during fetal life, as well as for at least the first decade of childhood. Become a Gold Supporter and see no third-party ads. [QxMD MEDLINE Link]. 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. Neuroimaging, as with CT and MRI, plays a minor role in the diagnosis of lead poisoning. 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) [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. 2017 Mar. Young children undergoing CT or MRI may need heavy sedation or general anesthesia. Dense transverse metaphyseal lines (mnemonic). J Trop Pediatr. [7]. A radiograph of the knee showing dense metaphyseal bands strongly supports the diagnosis of lead poisoning. Do not surround your terms in double-quotes ("") in this field. We have observed and described the evolution of the characteristic dense metaphyseal bands found in type V OI. [QxMD MEDLINE Link]. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Certain locations of missile fragments predispose the patient to lead poisoning or lead arthropathy. OMD is a rare sclerosing bone disorder inherited in an autosomal recessive manner. 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 (. Lead lines - The Lancet A bone-within-a-bone appearance has been described. 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. Dense vertical striations about the metaphyses are less common than transverse bands and are found in a selected group of disorders. 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. The differential diagnosis of dense metaphyseal bands is wide. Recurrent pericardial effusion due to gunshot wound of the heart in ahemodynamically stable child--a case report. Findings occur more frequently in younger patients with open epiphyses. Submitting a report will send us an email through our customer support system. These included striking rickets-like changes and marked osteopenia. Metaphyseal Bands - Syndrome Omim - RR School Of Nursing CLINICAL VIGNETTE JBMR - American Society for Bone and Mineral Research However, cerebral edema and microhemorrhages may be seen in patients presenting with encephalopathy. Start a 14-Day Trial for You or Your Team. (2003) ISBN: 9780702026508 -, 5. Caffeys Pediatric Diagnostic Imaging, 11th Ed.
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