Leukemic Infiltration

Epidemiology

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Etiology

  • AML:
  • CML:
  • ALL:
  • CLL:

Physiology

  • Leukemic cells directly infiltrating into the alveoli and interstitial

Diagnosis

  • FOB
    • BAL: may demonstrate leukemic cells
    • TBB: may demonstrate leukemic cells, but is usually not necessary
  • CXR/Chest CT Patterns
    • Focal or Multi-Focal Infiltrates:
      • In contrast, hyperleukocytic syndrome (pulmonary leukostasis) typically presents with diffuse infiltrates
    • Exudative Pleural Effusion: can occur in association with leukemic infiltrates
      • Effusions contain leukemic cells

Clinical

  • Characteristically presents as persistence of infiltrates, in the absence of identified infection, and despite appropriate antibiotic therapy
    • Dyspnea:
    • Hypoxemia:
    • Cough:
    • Pleuritic Chest Pain:
    • Tachypnea:

Treatment

  • Supportive Management:
  • Ventilatory support, treatment of concomitant infection, etc

Treatment of Underlying Leukemia:

  • It is not clear if pulmonary leukemic infiltration indicates a need for more intensive induction or consolidation chemotherapy

References

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