대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Chronic lymphocytic leukemia infiltration of lung

Radiologic Findings

Fig 1. Chest radiography showed ill-defined consolidation in the right lower lung field.
Fig 2-3. CT scans showed ground glass opacities with mild interlobular septal thickening in both lungs, predominantly in the right lower lobe. Multiple tiny centrilobular nodular opacities are also scattered in the both lungs. No pleural effusion.

The patient underwent video assisted thoracic surgery in the right lung and the final pathologic diagnosis was confirmed as lung infiltration of chronic lymphocytic leukemia (CLL) cells.

Brief Review

Leukemias are hematologic malignancies characterized by the production of abnormal white blood cells (leukocytes) in the bone marrow. Depending on the type of abnormal cells that are produced, leukemias are classified as myeloid (also known as myelogenous or myeloblastic) or lymphoid (also known as lymphocytic or lymphoblastic). Originally characterized as acute or chronic based on life expectancy, leukemias are now characterized as acute or chronic according to cellular maturity. Immature poorly differentiated cells (blast cells) predominate in acute leukemias, whereas mature (but abnormal) cells predominate in chronic leukemias.
Lymphadenopathy is the most common manifestation of leukemia in the thorax. Leukemia also may involve the lungs, pleura, heart, bones, and soft tissues. CT findings of leukemic pulmonary infiltration are nonspecific; however, leukemic cells have a tendency to involve the perilymphatic interstitium, producing smooth or nodular thickening of the bronchovascular bundles and interlobular septa. Pleural and pericardial effusions in patients with leukemia are more likely to be benign than malignant. Richter transformation occurs in 2%–8% of patients with CLL and is defined as the development of an aggressive lymphoma (diffuse large B-cell lymphoma, or much less commonly, Hodgkin lymphoma).

References

1. Shroff GS, Truong MT, Carter BW, Benveniste MF, Kanagal-Shamanna R, Rauch G, Viswanathan C, Boddu PC, Daver N, Wu CC. Leukemic Involvement in the Thorax. Radiographics. 2019 Jan-Feb;39(1):44-61.

Keywords

lung, chronic lymphocytic leukemia ,