Leukemia (thoracic manifestations)

Thoracic manifestations of leukaemia can be divided into those related to the disease itself and those associated with its treatment. Leukaemias are haematologic malignancies in which occur a proliferation of haematopoietic cells at an undifferentiated or partially differentiated stage of maturation.

Direct involvement

• lymphadenopathy
  • the most frequent manifestation of leukaemia in the thorax
  • commonly seen in lymphoid leukaemias
  • axillary lymphadenopathy is more common in CLL (~48%) ⁶
• pulmonary leukaemic infiltrates
  • extravascular collections of leukaemic cells in the lung parenchyma
  • found in about a quarter of patients in autopsy studies ⁶
  • overall similar distribution among the four major types of leukaemia ⁶
• pulmonary leukostasis
  • over-accumulation of leukaemic cells within the small vessels leading to obstruction ⁶
  • it is a medical emergency that presents clinically with acute respiratory failure
• pleural leukaemic infiltrates 
  • seen in up to a fifth of cases in autopsies series ⁶
  • commonly seen in advanced stages of chronic leukaemias 
  • on imaging, presents as pleural effusion and or soft tissue pleural thickening
• heart involvement 
  • present in about 25% of cases in autopsies series ⁶
  • usually asymptomatic 
  • can potentially involve the pericardium, the myocardium, and the endocardium 
• myeloid sarcoma
  • although the thorax is uncommonly involved, it may occur in the lungs, pleura, mediastinum, chest wall, and breast ⁶
  • the mediastinum is the most common site of myeloid sarcoma in the chest ⁶
• thoracic cage
  • for bone, muscular, and soft tissue involvement, please refer to the article on musculoskeletal manifestations of leukaemia
• associations: some conditions affecting the chest, although without having a clear mechanism of connection, have been reported to occur in patients with leukaemia
  • pulmonary alveolar proteinosis (PAP)
    • seen in the myeloid forms of leukaemia, particularly CML
  • amyloidosis
    • pulmonary amyloidosis
    • cardiac amyloidosis

Treatment-related complications

• superimposed infection
• alveolar haemorrhage
• pulmonary oedema
• leukaemic cell lysis pneumopathy
• chemotherapy toxicity
  • all-trans retinoic acid (ATRA) syndrome
• leukaemic cell lysis pneumopathy
  • ​acute respiratory failure after the initiation of chemotherapy, particularly in patients with hyperleukocytosis
  • features of acute respiratory distress syndrome (ARDS)