AP radiograph of the knee shows dense metaphyseal bands. De | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

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AP radiograph of the knee shows dense metaphyseal bands. Dense metaphyseal bands can be seen in a number of different conditions but are classically associated with lead poisoning. The incidence of lead poisoning has decreased over the last several decades as lead-based paints have been removed from homes. #MSKMonday

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Coronal MRI of the knees shows increased signal at the area of lucency seen on x-ray as well as abnormal signal in both the metaphyses and epiphyses. The differential diagnosis of lucent metaphyseal bands in a child includes lymphoma, neuroblastoma, and chronic recurrent multifocal osteomyelitis (CRMO). CRMO most commonly appears as multiple lytic and sclerotic metaphyseal lucencies. The tibia, femur, spine, pelvis, and medial clavicle are commonly involved. #FridayQuizDay

X-ray of the knee in an adolescent shows irregular lucent metaphyseal bands of the femur and tibia. What is your differential diagnosis? #FridayQuizDay

Radiograph of the abdomen (image 1) and zoomed-in image (image 2) in a child with elevated lead levels show linear metallic radiodensities (arrows) overlying the fecal stream consistent with ingested lead paint. Lead poisoning is now an uncommon entity as lead-based paint has not been used in home since 1980. Lead lines are another radiographic finding of lead poisoning and appear as dense metaphyseal lines within tubular bones.

a dense S/D/G band in Hb electrophoresis of a patient with positive sickling test.

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