What is the role of imaging studies in the workup of heavy metal toxicity?

Updated: Dec 31, 2020
  • Author: Adefris Adal, MD, MS; Chief Editor: Sage W Wiener, MD  more...
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Abdominal radiographs are indicated in acute ingestions. Radio-opacities demonstrable in the gastrointestinal tract should be cleared by whole-bowel irrigation prior to instituting chelation therapy. Large, retained gastric foreign bodies (eg, bullets, shotgun cartridges, fishing sinkers, curtain weights) may cause lead toxicity and should be removed endoscopically if they do not pass, if serum lead concentrations are concerning or increasing, or if the patient becomes symptomatic.

Several reported cases of patients who have injected elemental mercury subcutaneously and developed mercury toxicity have been documented. Radiographs of the suspect areas showing large subcutaneous deposits of radio-opaque material were helpful in confirming the diagnosis and need for surgical intervention to limit the exposure.

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