Table 3.
practical overview including radiological study, finding, location, take-home message, and link to the article.
| Author | Year | Image Study Modality (CT, X-ray, etc.) | Characteristic of Opacity | Location of Opacities | Differential Diagnosis | Take-Home Message | Link to the Article for Further Reference |
|---|---|---|---|---|---|---|---|
| Cerny et al. | 2006 | X-ray | Multiple, scattered radiopaque densities | Colon | Contrast medium (ruled out) | NR | Radiographic Appearance of Lanthanum|NEJM |
| David et al. | 2007 | X-ray + CT | Multiple, scattered radiopaque densities. | Intestines | NR | Lanthanum should temporarily be discontinued prior to image studies. Suggest that radiologic examinations could be used to monitor compliance in patients taking LC. | Heavy metal—rely on gut feelings: novel diagnostic approach to test drug compliance in patients with lanthanum intake|Nephrology Dialysis Transplantation|Oxford Academic (oup.com) |
| C-L Chuang et al. | 2007 | X-ray | Multiple, scattered radiopaque densities. | Intestines | Contrast medium (ruled out) | The phenomenon should be brought to the radiologist’s attention. | The Case∣A peritoneal dialysis patient with an unusual abdominal Film—ScienceDirect |
| Singanamala et al. | 2008 | X-ray | Single, round foreign body. | Aerodigestive tract | Foreign object | NR | Images in Dialysis Series Editors: Ursula C. Brewster and Mark A. Perazella: An Unexpected Finding on Chest Roentgenogram Following Hemodialysis Catheter Placement—Singanamala—2008—Seminars in Dialysis—Wiley Online Library |
| Pafcugová et al. | 2008 | X-ray + CT | Hyperdense elements with sharp edges + beam hardening. | Stomach | NR | Switch patients from lanthanum carbonate to a different phosphate binder prior to radiological examinations. | Radio-opaque appearance of lanthanum carbonate in a patient with chronic renal failure|Nephrology Dialysis Transplantation|Oxford Academic (oup.com) |
| Wu et al. | 2008 | X-ray | Multiple, scattered radiopaque densities. | Intestines | NR | Educating physicians can prevent misinterpretation. | A 56-year-old woman with starry radiopacities|Annals of Saudi Medicine (annsaudimed.net) |
| Badre et al. | 2008 | X-ray | Multiple, scattered radiopaque densities. | Upper left quadrant of abdomen→stomach. | NR | Tablets should be chewed completely prior to swallowing. | Unusual Abdominal Radio-opaque Densities in an ESRD Patient—Badre—2014—Seminars in Dialysis—Wiley Online Library |
| Kato et al. | 2009 | CT | Multiple, scattered radiopaque densities in intestines, and one case of a whole tablet seen in the terminal ileum together with digested residues in colon diverticulum. | Intestines | NR | LC should be used with caution in patients with diverticular flare-ups + in patients who are unable to chew tablets. | Accumulation of lanthanum carbonate in the digestive tracts|SpringerLink |
| Muller et al. | 2009 | X-ray + CT | Multiple, scattered radiopaque densities. | Intestines, especially in the rectosigmoid region. | NR | LC should be used with caution in patients with diverticular flare-ups + in patients who are unable to chew tablets. | confusional state associated with use of lanthanum carbonate in a dialysis patient: a case report|Nephrology Dialysis Transplantation | Oxford Academic (oup.com) |
| Connor et al. | 2009 | X-ray | Multiple, scattered radiopaque densities. | Colon | NR | Clinicians of all backgrounds should be aware of the distinctive radiological appearances seen in patients taking lanthanum carbonate. When possible, alternative phosphate binders should be temporarily employed before radiological examinations. | An unusual abdominal radiograph Postgraduate Medical Journal (bmj.com) |
| Turkmen et al. | 2009 | X-ray | Multiple, scattered radiopaque densities. | Throughout the ascending and transverse colon segments | NR | NR | An unusual hurdle to renal transplantation: speckled abdominal opacities induced by lanthanum carbonate—Turkmen—2010—Internal Medicine Journal—Wiley Online Library |
| Huijisoon et al. | 2009 | X-ray | Multiple, scattered radiopaque densities. | Intestines | Contrast medium (ruled out) | Patients should chew the tablets sufficiently. | Dustri Online Services |
| Hayashi et al. | 2010 | CT | Multiple, hyperdense elements with sharp edges + beam hardening. | Intestines | Foreign bodies | Radiologists should be familiar with the appearance of LC. Temporarily switch to a different phosphate binder before the radiological examination. If CT or X-ray is necessary, perform before administration of LC. | Beam-hardening artifacts on computed tomography images caused by lanthanum carbonate hydrate in a patient on dialysis SpringerLink |
| Chacko et al. | 2010 | X-ray | Multiple, scattered radiopaque densities. | Intestines | Sclerosing peritonitis, tuberculosis, and lead ingestion | Awareness of LCs radiopaque features will prevent unnecessary investigations. | Christmas lights in the gastrointestinal tract The Medical Journal of Australia (mja.com.au) |
| Hofmann et al. | 2010 | X-ray | Multiple, scattered radiopaque densities. | Colon | Oral or rectal contrast medium | NR | Colonic Opacification in a Patient with End-Stage Kidney Disease—Gastroenterology (gastrojournal.org) |
| Schmitt et al. | 2010 | X-ray + CT | Multiple, scattered radiopaque densities. | Intestines | NR | Proposes that Lanthanum should temporarily be discontinued prior to image studies | Layout 1 (nih.gov) |
| Fürstenberg et al. | 2010 | DEXA | Multiple, scattered radiopaque densities. | Intestines | NR | LC opacities in the GI tract can lead to erroneous overestimation of bone mineral content. | Overestimation of Lumbar Spine Calcium with Dual Energy X-Ray Absorptiometry Scanning due to the Prescription of Lanthanum Carbonate in Patients with Chronic Kidney Disease—Abstract—American Journal of Nephrology 2010, Vol. 32, No. 5—Karger Publishers |
| Crush et al. | 2010 | X-ray | Multiple, scattered radiopaque densities. | Colon | Contrast medium (ruled out) | Physicians should be informed about the phenomenon. | Perplexing plain abdominal X-ray Gut (bmj.com) |
| Walsh et al. | 2011 | DEXA | Multiple, scattered radiopaque densities. | Colon | Contrast medium | Lanthanum in the colon falsely increases BMD measurement. Suggests temporarily switching to a different phosphate binder before DXA scan if possible. | ClinicalKey |
| Vila-Navarro et al. | 2012 | X-ray | Multiple, scattered radiopaque densities. | Colon and appendix | Contrast medium (ruled out) | NR | 07_IPD_2384-Vila.ing_Maquetación 1 (grupoaran.com) |
| Muller et al. | 2012 | X-ray + CT | Radiopaque puddle with dilation and fecal impaction. | Stomach | NR | Chewing the tablet is essential. Caution is required if the patient suffers from constipation as he is at risk of developing a fecaloma or encephalopathy if the lanthanum serum content increases and crosses the brain blood barrier. | Radio-opaque fecal impaction and pseudo-occlusion in a dialyzed patient taking lanthanum carbonate—Muller—2012—Hemodialysis International—Wiley Online Library |
| Kuroiwa et al. | 2015 | UL + CT | Hyperecchoic signal in the intestines. | Intestines | NR | Anesthesiologists who perform transesophageal echocardiography and the abdominal US need to be familiar with the characteristics of LCH. | Lanthanum carbonate hydrate causes artifacts on ultrasound (nih.gov) |
| Salerno et al. | 2015 | CT | Multiple, hyperdense elements with sharp edges + beam hardening. | Intestines | Foreign bodies, intestinal bleeding. | One should pay more attention to the patient’s food habits as well as the drugs he is receiving to avoid misinterpretations of the radiological imaging studies. | The Risk of Mistaking Intestinal Lanthanum Carbonate for Intestinal Bleeding on CT (nih.gov) |
| Ruiz-Pardo et al. | 2016 | X-ray | Multiple scattered radiopaque densities. | Intestines | Contrast medium | NR | 10_IPD_3822_Ruiz.Ing.indd (reed.es) |
| Sahbudin et al. | 2016 | DEXA + X-ray | Multiple scattered radiopaque densities. | Intestines | NR | Alternative phosphate binders should be used. | Lanthanum carbonate in chronic renal failure|The BMJ |
| Nishikawa et al. | 2017 | CT | High-density layer around the entire circumference of the stomach wall. | Stomach wall | NR | Clinicians should be aware of this clinical condition as a possible cause of nausea | Lanthanum deposition in the gastric mucosa in a patient undergoing hemodialysis|QJM: An International Journal of Medicine|Oxford Academic (oup.com) |
| Harris et al. | 2017 | X-ray + CT | Multiple, scattered radiopaque densities (X-ray) + attenuation in the bowel wall and scattered opacities in the stomach and intestines (CT). | Intestines | Plebosclerotic colitis, hemorrhage | In Plebosclerotic colitis, it is unusual for the whole colon to be involved. | A case of lanthanum carbonate ingestion thought to be Plebosclerotic colitis on CT imaging and abdominal radiograph—ScienceDirect |
| Paranji et al. | 2017 | X-ray | A radiopaque coin-shaped foreign body. | aerodigestive tract | Foreign object | Tablets should be crushed/chewed sufficiently before swallowing due to the risk of aspiration. | All that glitters is not gold: A case of lanthanum carbonate aspiration—Suchitra Paranji, Neethi Paranji, Adam S Weltz, 2017 (sagepub.com) |
| Shitomi et al. | 2017 | CT | High-attenuating lines in the stomach wall. | Stomach | Non—proven to be lanthanum with biopsies | Coined lanthanum carbonate accumulation in the gastric mucosa “gastric lanthanosis”. The clinical implication is unknown. | Gastric lanthanosis (lanthanum deposition) in dialysis patients treated with lanthanum carbonate—Shitomi—2017—Pathology International—Wiley Online Library |
| Chang et al. | 2018 | X-ray + CT | Multiple, scattered radiopaque densities. | Colon | Barium contrast | Clinicians may take its radiopaque characteristic as an advantage to assess the patient’s drug adherence. | Starry-sky bowels|SpringerLink |
| Fischer et al. | 2019 | X-ray + CT | Multiple, scattered radiopaque densities. | Stomach, small intestines, and rectum. | Foreign bodies | Familiarity with the unique appearance of lanthanum carbonate on imaging can prevent misinterpretation of imaging modalities. | Page loading—ClinicalKey |
| Shiratori et al. | 2019 | CT | Hyperdensity areas in the stomach wall. | Stomach | NR | Esophagogastroduodenoscopy was performed showing white regional lesions due to Lanthanum carbonate deposition. | Lanthanum deposition in the gastric mucosa in a patient treated with hemodialysis BMJ Case Reports |
| Galo et al. | 2019 | UL + X-ray + CT | Multiple, scattered radiopaque densities. | Intestines | Foreign bodies and other drugs that typically cause radiopaque appearance. | The chewable tablets should be fully chewed or crushed prior to ingestion. One should first rule out abdominal diseases before prescribing lanthanum carbonate. Recognition of lanthanum carbonate artifacts can avoid extensive and costly use of medical resources for this benign condition. | Lanthanum-Induced Radiopaque Intestinal Precipitates: A Potential Cause of Intestinal Foreign Bodies (nih.gov) |