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J Pafčugová, M Horáčková, M Hrašková, J Forejt, M Szabo, R Pádr, Radio-opaque appearance of lanthanum carbonate in a patient with chronic renal failure, Nephrology Dialysis Transplantation, Volume 23, Issue 5, May 2008, Pages 1776–1777, https://doi.org/10.1093/ndt/gfn015
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Sir,
We have read an interesting case report concerning an X-ray finding in a patient taking lanthanum carbonate [ 1 ]. David et al. explain the opacification on radiographs by intestinal calcium phosphate accumulation. However, such strong opacification with a CT density of 3000 HU (Hounsfield value) has not been found in patients taking other types of phosphate binders including those containing calcium (CT density of bone 600 HU). In our opinion, there might be another explanation of this finding. Below, we describe a case of radio-opaque appearance of lanthanum in a patient taking this phosphate binder.
A 77-year-old man was admitted to a hospital for renal failure caused by complete obstructive ureterolithiasis in the solitary kidney. Haemodialysis was indicated due to elevated renal parameters (urea 28.0 mmol/l, serum creatinine 1079 μmol/l, phosphorus 2.45 mmol/l). Treatment with lanthanum carbonate was started in order to normalize serum phosphate levels. Surgical treatment of ureteral obstruction was necessary but the patient presented with haemodynamically significant supraventricular tachycardia. The ECG proved atrial flutter that was the indication to electrical cardioversion by cardiologists. Therefore, transesophageal echocardiography had to be carried out to exclude intracardial thrombi; these were not detected. The echocardiography also demonstrated an inexplicable finding on the thoracic aorta, and thus, computed tomography of the aorta was performed. The CT scan did not reveal any significant pathology of the aorta. However, a high-contrast substance of unknown origin and significance was captured in the stomach ( Figures 1 and 2 ). We performed an X-ray of lanthanum pills in a vial and detected the radio-opacity of lanthanum itself, even without calcium and phosphate ( Figure 3 ). This confirmed our suspicion that the high-contrast metallic-like substance in the stomach was a tablet of lanthanum. Lanthanum is a silvery white metallic element that belongs to group 3 of the periodic table. This drug exhibits little systemic absorption and low aqueous solubility. It is safe and well tolerated. We should bear in mind that abdominal X-rays of patients taking lanthanum carbonate may have a radio-opaque appearance typical of imaging agents and may affect abdominal X-ray findings ( Figure 1 , 2 ). Therefore, we should temporarily switch patients from lanthanum carbonate to a different phosphate binder prior to radiological examinations.
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