A 3-year-old child has unexplained bone pain. Plain X-ray shows transverse radiodense lines at the metaphyses of long bones ('growth arrest lines'). Which systemic condition classically produces these metaphyseal dense bands?

• A Lead poisoning ✓
• B Scurvy
• C Rickets
• D Osteogenesis imperfecta

Explanation

Lead lines (dense metaphyseal bands) at the metaphyses of long bones — especially the knee (distal femur, proximal tibia, fibula) — are caused by lead poisoning interfering with normal bone remodeling, producing abnormally dense provisional zones of calcification. Scurvy, by contrast, shows a 'white line of Frankel' (dense zone of calcification) with a subjacent lucent zone (Trummer field), corner fractures (Pelkan spurs), and periosteal hemorrhage. Rickets shows widened, irregular, cupped metaphyses. Osteogenesis imperfecta shows thin cortices and multiple fractures.

Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.