Radiology image of lanthanum carbonate
Imagen radiológica del carbonato de lantano
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The substance’s package leaflet in our country does not allude to the phenomenon of its appearance in radiology images. This is not the case in the USA’s version, which states that “radio-opaque images may appear in abdominal radiographies of patients who consume lanthanum”.<span class="elsevierStyleSup">1 </span>The most commonly reported adverse reactions were gastrointestinal, but the clinical trials did not include patients with intestinal obstructions or inflammatory intestinal disease.<span class="elsevierStyleSup">2 </span>We present the case of a 58-year old man with pan-colonic diverticulosis and frequent diverticulitis episodes with CKD secondary to diabetic nephropathy who began a periodic haemodialysis programme in April 2001. He was admitted in July 2008 for fever and abdominal pain. An emergency abdominal CT ruled out signs of diverticulitis, but the radiologist reported “remnants of contrast in the entire colon and terminal ileum” (figure 1), which was confirmed by a simple abdominal x-ray (figure 2). Our patient had not received any radiological contrast at any time, but he had been receiving treatment with 3000mg lanthanum carbonate daily for severe hyperphosphataemia since February of that year, with excellent lab results and good clinical tolerance up to that moment. The final diagnosis was sepsis due to <span class="elsevierStyleItalic">Enterococo avium</span>, most likely of intestinal origin. Since there were no other findings in the imaging tests that could explain the abdominal pain, lanthanum treatment was discontinued, after which the patient remained asymptomatic. With a view to studying the findings, a simple abdominal radiograph was taken in another patient receiving the same dose of that metal and who had not had any digestive symptoms. The deposit was also observed throughout the contour of the colon, but showed a different radiological pattern (figure 3). References in the literature describing this phenomenon are scarce and contain various explanations. According to our research, the first radiological image attributed to lanthanum consumption was shown by Cerny and Kunzendorf<span class="elsevierStyleSup">3 </span>in 2006. In this case, the drug was discontinued because after seeing the radiography, doctors felt that the patient’s abdominal pain could be related with the lanthanum. Other cases were subsequently reported.<span class="elsevierStyleSup">4 </span>David et al.<span class="elsevierStyleSup">5 </span>interpreted the radiograph as an intestinal deposit of calcium phosphate stones that prove lanthanum’s effectiveness as a binder, and even suggest that such an image could be used as a test of therapeutic compliance. That theory is refuted by Pafcugova et al.,<span class="elsevierStyleSup">6 </span>who showed that the tablets themselves inside a vial are radio-opaque, in absence of calcium or phosphorus. However, given our limited experience with the use of this drug, particularly in Spain, it is still not clear what the radiographical distribution pattern is in the abdomen, or whether it can be observed in all patients receiving this medication. Vrigneaud et al.<span class="elsevierStyleSup">7 </span>studied 13 patients treated with lanthanum. In six, the abdominal radiograph is completely normal, while in the rest, the radioopaque deposit may be observed. However, in contrast with the habitual images with opaque areas smaller than one centimetre distributed regularly throughout the contour of the colon, we found two cases in which the areas were larger and irregularly distributed along the digestive tract. These were in one patient who did not chew the tablets correctly, and another patient with colonic diverticulosis whose profile suggests the material was deposited in the diverticuli, as with the present case. Our conclusion is that although little data exists about the radiological behaviour of intestinal lanthanum carbonate deposits, it is necessary to know that it is radio-opaque. Furthermore, it is likely that the drug should be used cautiously in patients with intestinal diseases. In addition, we do not know its elimination time, which is crucial information when it comes to performing other imaging studies without interferences. And lastly, we believe that all of the above should be included in the drug’s technical leaflet printed in Spain.  </p><p class="elsevierStylePara"> </p><p class="elsevierStylePara"><a href="grande/10343108_a23_f1.jpg" class="elsevierStyleCrossRefs"><img src="10343108_a23_f1.jpg" alt="Abdominal CT without contrast showing the lanthanum carbonate deposit in the sigmoid colon diverticuli and rectum."></img></a></p><p class="elsevierStylePara">Figure 1. Abdominal CT without contrast showing the lanthanum carbonate deposit in the sigmoid colon diverticuli and rectum.</p><p class="elsevierStylePara"><a href="grande/10343108_a23_f2.jpg" class="elsevierStyleCrossRefs"><img src="10343108_a23_f2.jpg" alt="Simple abdominal radiography without contrast showing multiple onecentimetre sized opaque points irregularly distributed along the contour of the colon, which are lanthanum deposits in the diverticuli."></img></a></p><p class="elsevierStylePara">Figure 2. Simple abdominal radiography without contrast showing multiple onecentimetre sized opaque points irregularly distributed along the contour of the colon, which are lanthanum deposits in the diverticuli.</p><p class="elsevierStylePara"><a href="grande/10343108_a23_f3.jpg" class="elsevierStyleCrossRefs"><img src="10343108_a23_f3.jpg" alt="Simple abdominal radiography without contrast showing radio-opaque material distributed along the entire contour of the colon. This image is from another patient receiving the same dose of lanthanum, but with no abdominal symptoms."></img></a></p><p class="elsevierStylePara">Figure 3. Simple abdominal radiography without contrast showing radio-opaque material distributed along the entire contour of the colon. This image is from another patient receiving the same dose of lanthanum, but with no abdominal symptoms.</p>" "pdfFichero" => "P1-E47-S1884-A10343-EN.pdf" "tienePdf" => true "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10343108_a23_f1.jpg" "Alto" => 343 "Ancho" => 344 "Tamanyo" => 16850 ] ] "descripcion" => array:1 [ "en" => "Abdominal CT without contrast showing the lanthanum carbonate deposit in the sigmoid colon diverticuli and rectum." ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10343108_a23_f2.jpg" "Alto" => 294 "Ancho" => 344 "Tamanyo" => 14154 ] ] "descripcion" => array:1 [ "en" => "Simple abdominal radiography without contrast showing multiple onecentimetre sized opaque points irregularly distributed along the contour of the colon, which are lanthanum deposits in the diverticuli." ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10343108_a23_f3.jpg" "Alto" => 295 "Ancho" => 349 "Tamanyo" => 14425 ] ] "descripcion" => array:1 [ "en" => "Simple abdominal radiography without contrast showing radio-opaque material distributed along the entire contour of the colon. This image is from another patient receiving the same dose of lanthanum, but with no abdominal symptoms." ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lanthanum carbonate: Drug information. UpToDate 16.2. Obtenido el 31 de julio de 2008 en: http:// www.uptodate. com/online/content/topic.do?topicKey= drug_l_z/68079." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Persy VP, Behets GJ, Bervoets AR, De Broe ME, D¿Haese PC. Lanthanum: a safe phosphate binder. Semin Dial 2006;19:195-1999." 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| 2023 December | 60 | 24 | 84 |
| 2023 November | 84 | 68 | 152 |
| 2023 October | 115 | 48 | 163 |
| 2023 September | 122 | 35 | 157 |
| 2023 August | 97 | 27 | 124 |
| 2023 July | 80 | 39 | 119 |
| 2023 June | 79 | 28 | 107 |
| 2023 May | 95 | 41 | 136 |
| 2023 April | 42 | 40 | 82 |
| 2023 March | 74 | 30 | 104 |
| 2023 February | 67 | 23 | 90 |
| 2023 January | 70 | 34 | 104 |
| 2022 December | 86 | 34 | 120 |
| 2022 November | 81 | 53 | 134 |
| 2022 October | 68 | 76 | 144 |
| 2022 September | 86 | 50 | 136 |
| 2022 August | 90 | 54 | 144 |
| 2022 July | 68 | 58 | 126 |
| 2022 June | 59 | 58 | 117 |
| 2022 May | 73 | 32 | 105 |
| 2022 April | 53 | 62 | 115 |
| 2022 March | 73 | 48 | 121 |
| 2022 February | 78 | 50 | 128 |
| 2022 January | 104 | 34 | 138 |
| 2021 December | 53 | 48 | 101 |
| 2021 November | 63 | 52 | 115 |
| 2021 October | 97 | 48 | 145 |
| 2021 September | 67 | 33 | 100 |
| 2021 August | 60 | 33 | 93 |
| 2021 July | 94 | 26 | 120 |
| 2021 June | 65 | 32 | 97 |
| 2021 May | 70 | 33 | 103 |
| 2021 April | 79 | 69 | 148 |
| 2021 March | 103 | 25 | 128 |
| 2021 February | 100 | 16 | 116 |
| 2021 January | 49 | 23 | 72 |
| 2020 December | 62 | 15 | 77 |
| 2020 November | 58 | 11 | 69 |
| 2020 October | 40 | 3 | 43 |
| 2020 September | 58 | 9 | 67 |
| 2020 August | 62 | 10 | 72 |
| 2020 July | 78 | 5 | 83 |
| 2020 June | 59 | 12 | 71 |
| 2020 May | 88 | 10 | 98 |
| 2020 April | 59 | 12 | 71 |
| 2020 March | 57 | 15 | 72 |
| 2020 February | 77 | 13 | 90 |
| 2020 January | 70 | 24 | 94 |
| 2019 December | 88 | 23 | 111 |
| 2019 November | 76 | 20 | 96 |
| 2019 October | 44 | 7 | 51 |
| 2019 September | 79 | 19 | 98 |
| 2019 August | 63 | 7 | 70 |
| 2019 July | 52 | 20 | 72 |
| 2019 June | 39 | 15 | 54 |
| 2019 May | 47 | 12 | 59 |
| 2019 April | 79 | 28 | 107 |
| 2019 March | 42 | 22 | 64 |
| 2019 February | 29 | 18 | 47 |
| 2019 January | 50 | 23 | 73 |
| 2018 December | 90 | 35 | 125 |
| 2018 November | 155 | 7 | 162 |
| 2018 October | 149 | 12 | 161 |
| 2018 September | 111 | 17 | 128 |
| 2018 August | 70 | 13 | 83 |
| 2018 July | 72 | 14 | 86 |
| 2018 June | 80 | 11 | 91 |
| 2018 May | 59 | 12 | 71 |
| 2018 April | 80 | 9 | 89 |
| 2018 March | 78 | 10 | 88 |
| 2018 February | 65 | 7 | 72 |
| 2018 January | 68 | 7 | 75 |
| 2017 December | 70 | 6 | 76 |
| 2017 November | 62 | 15 | 77 |
| 2017 October | 52 | 5 | 57 |
| 2017 September | 55 | 15 | 70 |
| 2017 August | 57 | 9 | 66 |
| 2017 July | 59 | 8 | 67 |
| 2017 June | 48 | 9 | 57 |
| 2017 May | 67 | 5 | 72 |
| 2017 April | 51 | 5 | 56 |
| 2017 March | 59 | 5 | 64 |
| 2017 February | 132 | 9 | 141 |
| 2017 January | 41 | 8 | 49 |
| 2016 December | 64 | 7 | 71 |
| 2016 November | 87 | 11 | 98 |
| 2016 October | 175 | 7 | 182 |
| 2016 September | 293 | 9 | 302 |
| 2016 August | 294 | 7 | 301 |
| 2016 July | 232 | 6 | 238 |
| 2016 June | 170 | 0 | 170 |
| 2016 May | 185 | 0 | 185 |
| 2016 April | 135 | 0 | 135 |
| 2016 March | 114 | 0 | 114 |
| 2016 February | 106 | 0 | 106 |
| 2016 January | 112 | 0 | 112 |
| 2015 December | 140 | 0 | 140 |
| 2015 November | 98 | 0 | 98 |
| 2015 October | 104 | 0 | 104 |
| 2015 September | 102 | 0 | 102 |
| 2015 August | 91 | 0 | 91 |
| 2015 July | 88 | 0 | 88 |
| 2015 June | 38 | 0 | 38 |
| 2015 May | 45 | 0 | 45 |
| 2015 April | 8 | 0 | 8 |
Show all
