NDT Plus (2008) 2: 122–123
doi: 10.1093/ndtplus/sfm017
Advance Access publication 19 December 2007
Images in Nephrology
(Section Editor: G. H. Neild)
Intestinal radiopacities in a peritoneal dialysis patient
Maarten B. Rookmaaker1 and Wouter B. Veldhuis2
1
Department of Nephrology, UMC Utrecht, Huispost F 03.226, and 2 Department of Radiology, UMC Utrecht, Huispost E. 01.132,
Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
Keywords: lanthanum carbonate; peritoneal dialysis;
phosphate binders; plain abdominal film
Case
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.
Discussion
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).
∗ Correspondence
and offprint requests to: 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: [email protected]
Fig. 1. (a) Plain abdominal x-ray of a 64-year-old woman, showing innumerable opacifications projecting over her colon and rectosigmoid;
(b) conventional x-ray of a lanthanum carbonate tablet (top), a sevelamer
tablet (middle) and a calcium carbonate tablet (bottom). For comparison
of radiopacity, the tip of a metal kocher-forceps is also shown; (c) conventional x-ray of lanthanum carbonate tablet-fragments in faeces.
C The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
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Intestinal radiopacities in a peritoneal dialysis patient
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 be-
123
nign nature of these opacifications will prevent unnecessary
work-up of these patients.
Conflict of interest statement. None declared.
Received for publication: 29.10.07
Accepted in revised form: 6.11.07