NDT Plus Advance Access originally published online on December 19, 2007
NDT Plus 2008 1(2):122-123; doi:10.1093/ndtplus/sfm017
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Intestinal radiopacities in a peritoneal dialysis patient
1 Department of Nephrology, UMC Utrecht, Huispost F 03.226, The Netherlands
2 Department of Radiology, UMC Utrecht, Huispost E. 01.132, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
Correspondence: M. B. Rookmaaker, Department of Nephrology, UMC Utrecht, Huispost F 03.226, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands. Tel: +31-88-7555555; E-mail: m.rookmaaker{at}azu.nl
Key Words: lanthanum carbonate • peritoneal dialysis • phosphate binders • plain abdominal film
Received for publication October 29, 2007. Accepted for publication November 6, 2007.
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A plain abdominal x-ray of a 64-year-old woman, which was ordered to check the position of her catheter for ambulant peritoneal dialysis, showed innumerable opacifications projecting over her colon and rectosigmoid (Figure 1a). These opacifications were absent on an earlier x-ray 6 months previously.
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Common causes of intestinal opacifications are iodine- or barium-containing contrast media. Furthermore, telepaque and bismuth-containing drugs can cause such diffuse opacities. The patient had not undergone diagnostic procedures with intestinal contrast media, and she denied the use of any of the above medication.
Further inquiry revealed that because of persistent hyperphosphataemia, her sevelamer treatment had recently been supplemented with lanthanum carbonate tablets. The rare earth metal lanthanum is a trivalent cation with a high affinity for phosphate. The atomic number of lanthanum, 57, is comparable to that of the radiopaque alkaline earth metal barium, 56, used in contrast media. Figure 1b shows tablets of the phosphate-binding drugs lanthanum carbonate (top), sevelamer (middle) and calcium carbonate (bottom). For comparison of radiopacity, the tip of a metal kocher-forceps is also shown. The findings on her abdominal x-ray were thus most likely explained by intraluminal intestinal fragments of lanthanum carbonate tablets. This was confirmed by their excretion in the faeces (Figure 1c).
Lanthanum carbonate is a recent addition to the group of phosphate-binding drugs, and its distinct radiopaque appearance will be encountered with increasing frequency on x-ray-based diagnostic images. Knowledge of the benign nature of these opacifications will prevent unnecessary work-up of these patients.
Conflict of interest statement. None declared.
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