Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

MUSCULOSKELETAL
Year
: 2005  |  Volume : 15  |  Issue : 1  |  Page : 67--68

A rare case of lead poisoning - a case report


BR Nagaraj, Eshwarappa, PM Kumar 
 Dept Of Radio Diagnosis, Vani Vilas Women And Children Hospital, Bangalore Medical College, Bangalore., India

Correspondence Address:
B R Nagaraj
Dept Of Radio Diagnosis, Vani Vilas Women And Children Hospital, Bangalore Medical College, Bangalore.
India




How to cite this article:
Nagaraj B R, Eshwarappa, Kumar P M. A rare case of lead poisoning - a case report.Indian J Radiol Imaging 2005;15:67-68


How to cite this URL:
Nagaraj B R, Eshwarappa, Kumar P M. A rare case of lead poisoning - a case report. Indian J Radiol Imaging [serial online] 2005 [cited 2019 Aug 25 ];15:67-68
Available from: http://www.ijri.org/text.asp?2005/15/1/67/28748


Full Text

 Introduction



Lead poisoning occurs either following ingestion of the metals or its compounds or by inhalation of fumes of lead oxide. In children poisoning is mainly due to ingestion, whereas in adults it is due to occupational inhalation. Congenital lead poisoning in the fetus may occur following Ingestion of illegally produced alcohol by the mother during pregnancy.

 Case report



A 5months old female child born to Assamese parents presented with h/o vomiting -4 days, convulsion-1 episode, passage of watery stools 3 times a day. Child was drowsy and irritable but arousable, anterior fontanellae measured 2 X 2 cms, pulsatile, tensed, prominent parietal eminences, motor system-power 4/5,pallor was present. With these Symptoms child was referred to RD department of Vani Vilas Women & Children Hospital for wrists & chest radiogram to rule out rickets & chest infection respectively.

Radiogram of wrist and hand revealed thick metaphyseal bands in the distal ends of radius & ulna, both ends of metacarpals and bases of all the phalanges. Routine Chest Radiogram revealed splaying in the Anterior ends of the Ribs .and in the Metaphysis of Humeri. Lung fields were clear, cardia was normal. A Probable diagnosis of lead poisoning was made.

Skeletal survey was done which included - Radiogram of Pelvis, Femora, Knee Joints, Proximal Ends of Tibia / Fibula, Feet with ankle Joints which further confirmed the diagnosis of Lead Poisoning.

 RADIOLOGICAL FEATURES



1. WRIST : Dense Metaphyseal bands seen in the distal ends of radius /ulna ,both proximal and distal ends of Metacarpals and Bases of Phalanges

2.CHEST RADIOGRAM P A VIEW : Chest radiogram revealed splaying of anterior ends of ribs with increased bone density. Lung fields were clear, cardiac shadow was normal. Proximal ends of humeri revealed dense metaphyseal bands

3.RADIOGRAM OF PELVIS WITH FEMORA AND KNEE JOINTS :. Thick Metaphyseal bands in the distal ends of femora, Proximal ends of tibia / fibula with Modelling defects with normal knee joint space.

4.FEET WITH ANKLE JOINTS : Thick Metaphyseal bands seen in both ends of metatarsals and bases of phalanges.

INVESTIGATIONS- DONE AT VVH

1. Hb%-9.6gm%,

2. Rbs-81mgs%,

3. Serum calcium-10mg%,

4. Serum inorganic phosphate 8.0mg/dl,

5. ZPP-182 micro gram/dls

6. U/S SCAN OF ABDOMEN & PELVIS: revealed mild hepatospleenomegaly.

7. Cranial ultrasound revealed no abnormality .Ventricles were normal, brain parenchyma and choroid plexi were normal

8. The Blood lead levels were confirmed at a reputed laboratory which showed increased Blood lead level of 97micro gram/dl, (normal- 7-9mcg/dl).[1] Parents also tested positive for increased blood lead levels which favoured the possibility of endemicity in the lead poisoning.

 DISCUSSION



Areas of increased bone density / metaphyseal bands are due to very tight spongiosa caused by calcium deposition with in the cartilaginous matrix.[2]

It is more serious when children are exposed to lead, whose brain development is not complete. Elevated levels of lead sustained over a period of time, can damage the CNS of children and adversely impact their development and can also cause damage to circulatory and blood forming system, reproductive system, kidneys, G.I.T with variations of symptoms.[3],[4]

 DIFFERENTIAL DIAGNOSIS

[5]

1. Poisoning due to other heavy metals.

2. Healed rickets.

3. Scurvy.

4. Post-traumatic.

5. Osteosclerotic metaphyseal dysplasia. CONCLUSION : Lead Poisoining In This Child Was Mainly Due To Ingestion Of Lead Secondary To Breast Feeding, Whose Parents Also Tested Positive For High Blood Lead Levels And Hails From An Endemic Area [Assam].

 CONCLUSION



Lead Poisoining In This Child Was Mainly Due To Ingestion Of Lead Secondary To Breast Feeding, Whose Parents Also Tested Positive For High Blood Lead Levels And Hails From An Endemic Area [Assam].

References

1Wilhelm M, Int Journal Of Hygine, Environ Health 2004 Jan (1): 69-73.
2Caffeys Paediatric X Ray Diagnosis Vol 2 , Page 1526.
3Principles And Practice Of Paeditrics, 2nd Edition (Frank A. Oski Page No 843.
4Ectotoxicology And Environmental Safety Vol 53, Issue 2, Oct 2002; 259-266.
5Dd In Conventional Radiology, 2nd Edition, Francis A. Burgener Page 240