Lead poisoning

Lead poisoning or plumbism can present with characteristic skeletal features.

Epidemiology

This condition usually occurs as a consequence of a toxic environment: prolonged ingestion or inhalation of lead-containing material (e.g. contaminated water, paints, batteries).

Pathology

Lead accumulates in the metaphyses of growing bones, which are the most metabolically active zone. It is an osteoclast-poison, so bone density is increased due to unopposed action of osteoblasts.

Radiographic features

Plain radiograph

• may show bands of increased density at the metaphysis
• can affect any metaphysis, but the involvement of proximal fibula and distal ulnar metaphysis is highly suggestive
• may show a bone-in-bone appearance.

Differential diagnosis

• healed rickets
• physiological appearances in <3 years age group

See also: differential for dense metaphyseal bands.