Pulmonary leukostasis: radiologic-pathologic study.

Buchem, Mark A. van; Wondergem, J.; Kool, Leo J. Schultze; Velde, J. te; Kluin, Philippus; Bode, P. J.; Busscher, D. L. T.

doi:10.1148/radiology.165.3.3479813

Cited by 37 publications

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“…Leukostasis (aggregation of blasts in pulmonary microvascularization) is exceptional and it will only be suspected in the diagnosis or relapse of an AML due to a rapid increase of the percentage of leucocytes in blood; it is characterized by respiratory and neurological failure kicking in with con pulmonary consolidations partly due to alveolar damage and hemorrhages due to plateletpenia. 38,39 In MM, consolidations due to pulmonary infiltration of plasmatic cells causing respiratory distress of poor prognosis have also been described. 20,40 Noninfectious complications secondary to treatment In the 6 h following the transfusion of blood products, the sudden appearance of consolidations simulating an edema and accompanying a respiratory failure usually reflect acute pulmonary damage (APD) called TRALI (transfusion-related alveolar lung injury) which associates high mortality rates.…”

Section: Disease Noninfectious Complicationsmentioning

confidence: 99%

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Batlles

Polo

Sanz

et al. 2015

Radiología (English Edition)

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Lung disease is very common in patients with hematologic neoplasms and varies in function of the underlying disease and its treatment. Lung involvement is associated with high morbidity and mortality, so it requires early appropriate treatment. Chest computed tomography (CT) and the analysis of biologic specimens are the first line diagnostic tools in these patients, and sometimes invasive methods are necessary. Interpreting the images requires an analysis of the clinical context, which is often complex. Starting from the knowledge about the differential diagnosis of lung findings that radiologists acquire during training, this article aims to explain the key clinical and radiological aspects that make it possible to orient the diagnosis correctly and to understand the current role of CT in the treatment strategy for this group of patients. Neoplasias hematológicas; Trasplante de precursores hematopoyéticos; Neoplasias hematológicas: interpretación de los hallazgos pulmonares en la tomografía computarizada torácicaResumen La patología pulmonar en la historia de un paciente con neoplasia hematológica es muy frecuente y variable en función de la enfermedad de base y la terapia recibida. La morbimortalidad asociada es alta, por lo que requiere un tratamiento correcto y precoz. La tomografía computarizada (TC) torácica, junto con el análisis de muestras biológicas, son las ଝ Please cite this article as: Calvillo Batllés P, Carreres Polo J, Sanz Caballer J, Salavert Lletí M, Compte Torrero L. Neoplasias hematológicas: interpretación de los hallazgos pulmonares en la tomografía computarizada torácica. Radiología. 2015;57:455---470. P. Calvillo Batllés et al.Tomografía computarizada multidetector; Enfermedad pulmonar herramientas de diagnóstico de primera línea empleadas en estos pacientes, y en determinados casos se requieren métodos invasivos. La interpretación de las imágenes exige el análisis de un contexto clínico en muchas ocasiones complejo. Partiendo del conocimiento que adquiere el radiólogo en su formación sobre el diagnóstico diferencial de los hallazgos pulmonares, el objetivo de este trabajo es explicar los aspectos clínicos y radiológicos claves que permiten orientar correctamente el diagnóstico y asimilar el papel actual de la TC en la estrategia terapéutica de este grupo de enfermos.

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Section: Disease Noninfectious Complicationsmentioning

confidence: 99%

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Batlles

Polo

Sanz

et al. 2015

Radiología (English Edition)

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“…In the literature, there is no consensus with regard to diagnostic criteria on chest radiography in patients with pulmonary leucostasis. The pulmonary infiltrates are being described as either diffuse alveolar or interstitial3 6 7 and almost exclusively bilateral 2 3. Since our patient had no clear clinical symptoms of leucostasis, that is, absence of headache and blurred vision together with initially unilateral pulmonary infiltrates, this syndrome was not directly recognised and treatment was primarily aimed at an infectiological cause.…”

Section: Discussionmentioning

confidence: 80%

“…Diagnosis of pulmonary leucostasis is suggestive when respiratory distress is present together with pulmonary infiltrates on chest radiographics. In some patients, however, chest X-ray can be normal despite microscopic leucostasis 3. The presence of radiographic abnormalities may be explained by concomitant alveolar oedema, which is probably the result of diffuse endothelial damage from either simple embolic ischaemia aggravated by continuing oxygen consumption of the sludged leukaemic cells or the release of proteolytic enzymes from those cells and the generation of toxic oxygen compounds 1 4 5.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary leucostasis syndrome presented by unilateral pulmonary infiltrates

2014

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SummaryA 48-year-old woman presented with suspected acute myelogenous leukaemia with a leucocyte count of 80×109/L. On admission, she had high fever and shortness of breath. Chest X-ray demonstrated unilateral consolidations of right lung suggestive for pneumonia and broad spectrum antibiotics were started. Her condition rapidly deteriorated and despite the clinical diagnosis of pulmonary leucostasis and treatment with leucapheresis the patient died within 2 days after admission from progressive respiratory failure and multiorgan failure. Autopsy showed diffuse leucostasis in the pulmonary capillaries. The present case illustrates that pulmonary leucostasis may be presented by unilateral chest X-ray abnormalities and without clear neurological symptoms (headache and blurred vision). Clinicians should be aware of this since delayed treatment may increase mortality.

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“…Chest CT and radiograph findings did not reveal the diffuse interstitial or alveolar infiltrates typically associated with leukostasis , nor did she exhibit fever or neurological symptoms, findings common in leukostasis . Having said this, we must acknowledge that, on occasion, patients with pulmonary leukostasis may not manifest abnormal chest radiograph findings , and positive imaging findings are not considered a formal diagnostic criterion for pulmonary leukostasis , therefore we cannot claim with certainty that she did not have leukostasis. In addition, an alternative mechanism by which hyperleukocytosis, even with a mature phenotype, would have caused her pulmonary symptoms is not immediately apparent.…”

Section: Discussionmentioning

confidence: 96%

Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype

Kwan

Linden

Gaffney

et al. 2015

J of Clinical Apheresis

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Mantle cell lymphoma is an aggressive malignant B-cell disorder that often presents with a leukemic picture. Circulating lymphoma cell morphology may vary from small round mature-appearing lymphocytes resembling the lymphocytes of chronic lymphocytic leukemia to large prolymphocytoid or blastoid cells. Rare reports of hyperleukocytosis with leukostasis, treated with leukocytapheresis, are described in patients with prolymphocytoid or blastoid morphology. We report an 88 year old woman with mantle cell lymphoma, hyperleukocytosis (WBC > 400 × 10(3) /µL) with severe respiratory compromise but without interstitial or alveolar infiltrates on radiograph or computerized tomography of the chest. She was afebrile and had no central nervous system signs. Circulating lymphoma cell morphology was predominantly of the small lymphocyte type. A two-whole-blood-volume leukocytapheresis reduced her WBC from 465 to 221 × 10(3) /µL in 150 min. Her respiratory rate decreased from 28/min to 18/min and her arterial oxygen saturation (SpO2 ) rose from 91% to 97% on 6 L/min of oxygen by nasal cannula. Severe breathlessness before the procedure abated completely by the end of the procedure. Respiratory compromise may occur in mantle cell lymphoma with hyperleukocytosis with a mature lymphoma cell phenotype, even without a clear picture of leukostasis. Although the ultimate survival of the patient depends on treatment with chemotherapy, leukocytapheresis for alleviation of symptoms may be warranted and should be considered. Respiratory status and response to leukocytapheresis should be documented with physiological measurements. J. Clin. Apheresis 31:398-402, 2016. © 2015 Wiley Periodicals, Inc.

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Pulmonary leukostasis: radiologic-pathologic study.

Cited by 37 publications

References 0 publications

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Pulmonary leucostasis syndrome presented by unilateral pulmonary infiltrates

Therapeutic leukocytapheresis for improvement in respiratory function in a woman with hyperleukocytosis and mantle cell lymphoma with a circulating small lymphocyte phenotype

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