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.

Thoracic manifestations directly attributed to leukaemia

• 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

Leukaemia treatment-related thoracic 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) 

See also

• systemic involvement of leukaemia 

  • CNS manifestations

  • testicular manifestations

  • musculoskeletal manifestations