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Differential Diagnosis
- Chondrocalcinosis
- Lead arthropathy
- Lead synovitis
- Osteoarthritis
Diagnosis
The correct diagnosis is lead arthropathy. The x-ray shows a large dominant posterior bullet fragment with innumerable metallic densities overlying the degenerated ankle joint. The retained intra-articular bullet caused a severe proliferative synovitis and a progressive, destructive arthritis. Systemic lead intoxication has been reported when bullets remain bathed in synovial fluid.
Learnings/What to Look for
- The radiographic identification of intraarticular bullet fragments should prompt an urgent orthopedic consultation. Timely removal of lead particles and debridement of the bone and cartilage fragments will prevent both lead arthropathy and toxicity
Pearls for Urgent Care Management
- If lead arthropathy is identified, synovectomy and joint replacement are often necessary. All patients with lead arthropathy should be evaluated for systemic lead toxicity
Acknowledgment: Image and case presented by Experity Teleradiology (www.experity.com/teleradiology).
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