Leukemia (thoracic manifestations)

Last revised by Dr Yuranga Weerakkody on 05 Mar 2020

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

Direct involvement
  • lymphadenopathy
    • the most frequent manifestation of leukemia in the thorax
    • commonly seen in lymphoid leukaemias
    • axillary lymphadenopathy is more common in CLL (~48%) 6
  • pulmonary leukemic infiltrates
    • extravascular collections of leukemic 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 leukemia 6
  • pulmonary leukostasis
    • over-accumulation of leukemic cells within the small vessels leading to obstruction 6
    • it is a medical emergency that presents clinically with acute respiratory failure
  • pleural leukemic 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
  • associations: some conditions affecting the chest, although without having a clear mechanism of connection, have been reported to occur in patients with leukemia
Treatment-related complications

See also

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