Chief Complaints: cough and whitish sputum
Two years ago, he received chemotherapy for chronic lymphocytic leukemia.

Findings
    Chest PA shows multiple, relatively well-marginated variable sized nodules scattering in both lung fields. CT scan reveals multiple enhancing nodules in both lungs. Some nodules contain air-bronchogram.

Discussion
    Several abnormalities may be seen at chest imaging in leukemic patients. These can be divided into three categories: (1) leukemic infiltration of the lungs or pleura, (2) intrathoracic lymph node enlargement caused by leukemia, (3) noneoplastic complications of leukemia or its treatment, notably pulmonary infection, pulmonary hemorrhage, pulmonary edema, drug reactions. When diffuse shadowing was present, the shadowing was highly likely to represent pneumonia or hemorrhage. Focal shadows may represent a variety of pathologic conditions, including infarction, neoplasm, hemorrhage, and granulomatous infection.
    Chronic lymphocytic leukemia(CLL) is a lymphoproliferative disorder characterized by the proliferation of small, mature-appearing lymphocytes, usually of B-cell type. CLL may evolve into large cell lymphoma(Richter’s syndrome), prolymphocytic leukemia, acute lymphoblastic leukemia, and myeloma. In the case of Richter’s syndrome, the lymphoma may occur as a result of malignant transformation of the CLL cells or, alternatively, it may represent a second malignancy arising from a clone of cells distinct from the CLL cells.
    The most common radiological appearance of pulmonary lymphoma is poorly defined consolidation and air-bronchogram. Less common radiographic patterns include nodules, diffuse bilateral air space consolidation, and segmental or lobar atelectasis. Nodules can be cavitate. Involvement of pulmonary lymphatics can produce interlobular septal thickening.

References
1. Wetzler M, Kurzrock R, Goodacre AM, McLaughlin P, Ku S, Talpaz M.Transformation of chronic lymphocytic leukemia to lymphoma of true histiocytic type. Cancer. 1995;76(4):609-617.
2. Armstrong P, Wilson AG, Dee P, Hansell DM. Imaging of diseases of the chest. 2nd ed. pp336- 339.