Unusual image of lanthanum carbonate in the abdominal radiograph
Unusual image of lanthanum carbonate in the abdominal radiograph
Unusual image of lanthanum carbonate in the abdominal radiograph
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1130-0108/2012/104/7/379-380<br />
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS<br />
Copyright © 2012 ARÁN EDICIONES, S. L.<br />
<strong>Unusual</strong> <strong>image</strong> <strong>of</strong> <strong>lanthanum</strong> <strong>carbonate</strong> <strong>in</strong> <strong>the</strong> abdom<strong>in</strong>al<br />
<strong>radiograph</strong><br />
Silvia Vila-Navarro 1 , Gorg<strong>in</strong>a Elisa Gomila-Roy 2 , Adriana Hemfelt-M<strong>in</strong>obis 2 , Sam Khorrami-M<strong>in</strong>aei 1<br />
and Daniel G<strong>in</strong>ard-Vicens 1<br />
1 Servicio de Aparato Digestivo. Hospital Son Espases. Palma de Mallorca. Spa<strong>in</strong><br />
2 Atención Primaria. Palma de Mallorca. Spa<strong>in</strong><br />
CASE REPORT<br />
A 73-year-old male with history <strong>of</strong> advanced chronic kidney disease on haemodialysis was admitted to <strong>the</strong> emergency<br />
room due to one week <strong>of</strong> diffuse abdom<strong>in</strong>al pa<strong>in</strong> and diarrhoea. He had no pathological products <strong>in</strong> <strong>the</strong> stools or fever.<br />
Physical exam<strong>in</strong>ation was anodyne and blood tests were compatible with his underly<strong>in</strong>g disease. The results <strong>of</strong> microbiological<br />
tests <strong>of</strong> stools were also negative. The abdom<strong>in</strong>al X-ray revealed <strong>the</strong> presence <strong>of</strong> calcium density accumulations distributed<br />
homogeneously through <strong>the</strong> colon and appendix (Fig. 1).<br />
The patient denied recent studies with iod<strong>in</strong>ated contrast. Review<strong>in</strong>g his current medical treatment, <strong>lanthanum</strong> <strong>carbonate</strong><br />
was needed to control a secondary hypophosphatemia. The abdom<strong>in</strong>al X-ray was repeated 48 hours after discont<strong>in</strong>uation<br />
<strong>of</strong> <strong>the</strong> drug and showed a change <strong>in</strong> <strong>the</strong> distribution <strong>of</strong> <strong>the</strong> radiopaque material (Fig. 2).<br />
DISCUSSION<br />
PICTURES IN DIGESTIVE PATHOLOGY<br />
REV ESP ENFERM DIG (Madrid)<br />
Vol. 104. N.° 7, pp. 379-380, 2012<br />
Lanthanum <strong>carbonate</strong> is a non-toxic non-absorbable heavy metal, which acts as a phosphate b<strong>in</strong>der. In some cases, its<br />
accumulation <strong>in</strong> <strong>the</strong> digestive tract can result <strong>in</strong> radiopaque <strong>image</strong>s, mimick<strong>in</strong>g iod<strong>in</strong>ated contrast. Abdom<strong>in</strong>al discomfort<br />
Fig. 1. Ple<strong>in</strong> abdom<strong>in</strong>al X-ray at hospitalization.<br />
Fig. 2. Ple<strong>in</strong> abdom<strong>in</strong>al X-ray at hospital discharge.
380 S. VILA-NAVARRO ET AL. REV ESP ENFERM DIG (Madrid)<br />
and diarrhoea are both common adverse effects <strong>of</strong> <strong>lanthanum</strong>, but not necessarily associated with <strong>the</strong> radiological f<strong>in</strong>d<strong>in</strong>gs<br />
described above. In our case, symptoms were limited <strong>the</strong>mselves and <strong>the</strong> drug was re<strong>in</strong>troduced.<br />
REFERENCES<br />
1. Tonelli M, Pannu N, Manns B. Oral Phosphate B<strong>in</strong>ders <strong>in</strong> patients with Kidney Failuren. N Eng J Med 2010;362:1312-24.<br />
2. Diez B, Medrano M, Alonso A. Imagen radiológica del carbonato de lantano. Nefrología 2010;30:263-4.<br />
3. Vrigneaud L, Lefèbe D, Daem AO, Lemaitre V. Aspects <strong>radiograph</strong>iques de l’absorption digestive du <strong>carbonate</strong> de Lanthane. Nephrol Ther 2008;4:111-3.<br />
4. Persy VP, Behets GJ, Bervoets AR, De Broe ME, D’Haese PC. Lanthanum: a safe phosphate b<strong>in</strong>der. Sem<strong>in</strong> Dial 2006;19:195-9.<br />
REV ESP ENFERM DIG 2012; 104 (7): 379-380