Leukemia (thoracic manifestations)
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%)
- pulmonary leukemic infiltrates
- extravascular collections of leukemic cells in the lung parenchyma
- found in about a quarter of patients in autopsy studies
- overall similar distribution among the four major types of leukemia
- pulmonary leukostasis
- over-accumulation of leukemic cells within the small vessels leading to obstruction
- 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
- 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
- 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
- the mediastinum is the most common site of myeloid sarcoma in the chest
- thoracic cage
- for bone, muscular, and soft tissue involvement, please refer to the article on musculoskeletal manifestations of leukemia
- associations: some conditions affecting the chest, although without having a clear mechanism of connection, have been reported to occur in patients with leukemia
- pulmonary alveolar proteinosis (PAP)
- seen in the myeloid forms of leukemia, particularly CML
- amyloidosis
- pulmonary alveolar proteinosis (PAP)
Treatment-related complications
- superimposed infection
- alveolar hemorrhage
- pulmonary edema
- leukemic cell lysis pneumopathy
- chemotherapy toxicity
- leukemic 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 leukemia
Siehe auch:
- Milchglasverschattungen
- thickening of bronchovascular bundles
- focal homogeneous pulmonary opacities
- prominence of peripheral pulmonary arteries
und weiter:
Assoziationen und Differentialdiagnosen zu pulmonale Manifestationen der Leukämie: