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 alveolar proteinosis (PAP)
Treatment-related complications
- superimposed infection
- alveolar haemorrhage
- pulmonary oedema
- leukaemic cell lysis pneumopathy
- chemotherapy toxicity
-
leukaemic cell lysis pneumopathy
- acute respiratory failure after the initiation of chemotherapy, particularly in patients with hyperleukocytosis
- features of acute respiratory distress syndrome (ARDS)
See also
- systemic involvement of leukaemia