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Lead lines in young infants with acute lead encephalopathy: a reliable diagnostic test
D A Woolf1, I C Riach, A Derweesh
1Department of Child Health, Royal Hospital, Muscat, Sultanate of Oman.
Insights
Plain skeletal radiology revealed dense metaphyseal bands in Omani infants with lead encephalopathy. This finding, particularly visible around the knee, aids in diagnosing lead poisoning in young children.
Area of Science:
- Pediatric Radiology
- Toxicology
- Neurology
Background:
- Lead encephalopathy is a severe neurological condition in infants.
- Early diagnosis is crucial for effective management and preventing long-term sequelae.
- Radiographic findings can aid in the diagnosis of lead poisoning.
Purpose of the Study:
- To evaluate the utility of plain skeletal radiology in diagnosing lead encephalopathy in Omani infants.
- To identify characteristic radiographic findings associated with lead poisoning in this population.
Main Methods:
- Plain skeletal radiography was performed on 15 Omani infants (2-4 months old) diagnosed with acute lead encephalopathy.
- Radiographs were analyzed for the presence and location of lead lines, specifically dense metaphyseal bands.
Main Results:
- All 15 infants exhibited dense metaphyseal bands in their long bones, most prominent around the knee.
- Six infants showed multiple lead lines, suggesting prior lead exposure.
- Four infants also had lead lines in the axial skeleton.
Conclusions:
- Dense metaphyseal bands on plain X-rays, especially of the knee, are a strong indicator of lead poisoning in infants with unexplained encephalopathy.
- Plain knee X-rays are a cost-effective, accessible, and rapid diagnostic tool for suspected lead poisoning.
Abstract:
Fifteen Omani infants, ranging between 2 and 4 months of age, with acute lead encephalopathy underwent plain skeletal radiology. X-rays in all 15 infants revealed dense metaphyseal bands in long bones. These were best seen around the knee joint. Six infants had evidence of multiple lead lines indicating previous episodes of exposure to lead while four infants also had lead lines in the axial skeleton. We suggest that any young infant presenting with an unexplained encephalopathy should undergo an X-ray of the knee and that the presence of dense metaphyseal bands strongly supports the diagnosis of lead poisoning. A plain X-ray of the knee is a cheap, widely available investigation which can be rapidly obtained.
