Beam-hardening artifacts on computed tomography images caused by lanthanum carbonate hydrate in a patient on dialysis

Lanthanum carbonate hydrate is a nonaluminum, noncalcium phosphate binder containing lanthanum (La). It is effective in decreasing the serum phosphate level in patients on dialysis. Because the atomic number of the La contained in lanthanum carbonate hydrate is relatively high, at 57, this agent may cause strong artifacts on computed tomography (CT) images, which may be mistakenly interpreted as foreign bodies. We recently performed CT examination of a patient on Fosrenol chewable tablets (i.e., lanthanum carbonate hydrate). The CT images were difficult to evaluate because of strong beam hardening artifacts, and differentiation from foreign body aspiration was required. We report here our experience and a discussion of the characteristics of this artifact.