Abstract

Hyperleukocytic acute myeloid leukemia (AML) is associated with pulmonary complications and high early mortality rate, but given its rarity, data on chest radiographic presentation are scarce. We retrospectively reviewed the charts of 73 AML patients admitted with white blood cell count >100-109/L between 2003 and 2014 in order to describe the chest radiographic and computed tomography (CT) findings and to correlate them with AML subtype and respiratory symptoms. Forty-two of the 73 patients (58%) overall and 36 of the 54 patients (67%) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission. The presence of radiographic abnormalities was significantly associated with dyspnea and oxygen/ ventilatory support requirements (P<0.01) and with day 28 mortality (45% vs 13%, P=0.005) but not with monocytic subtype of AML. Sixteen patients had isolated focal basilar airspace opacities, unilateral (n=13) or bilateral (n=3), while 16 patients had bilateral diffuse opacities, interstitial (n=12) or airspace and interstitial (n=4). Two patients had isolated pleural effusion, 2 patients had unilateral midlung airspace opacities, and 6 patients had a combination of focal airspace and diffuse interstitial opacities. Overall, 2 patterns accounted for 75% of abnormal findings: bilateral diffuse opacities tended to be associated with monocytic AML, whereas basilar focal airspace opacities were more frequent in nonmonocytic AML (P<0.05). Eighteen patients had CT scans, revealing interlobular septal thickening (n=12), airspace (n=11) and ground-glass (n=9) opacities, pleural effusions (n=12), and acute pulmonary embolism (n=2). Hyperleukocytic AML is frequently associated with abnormal chest radiographs, involving mostly focal basilar airspace opacities (more frequent in nonmonocytic AML) or diffuse bilateral opacities. CT scan should be considered broadly due to the suboptimal resolution of radiographs for detecting signs of leukostasis.

Original languageEnglish (US)
Article numbere5285
JournalMedicine (United States)
Volume95
Issue number44
DOIs
StatePublished - Jan 1 2016

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X Ray Tomography
Acute Myeloid Leukemia
Cohort Studies
Thorax
Retrospective Studies
Leukostasis
Pleural Effusion
Tomography
Lung
Mortality
Pulmonary Embolism
Leukocyte Count
Dyspnea
Glass
Oxygen

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{1ee1dbeca80d47b38b883919b5402942,
title = "Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia A retrospective cohort study of 73 patients",
abstract = "Hyperleukocytic acute myeloid leukemia (AML) is associated with pulmonary complications and high early mortality rate, but given its rarity, data on chest radiographic presentation are scarce. We retrospectively reviewed the charts of 73 AML patients admitted with white blood cell count >100-109/L between 2003 and 2014 in order to describe the chest radiographic and computed tomography (CT) findings and to correlate them with AML subtype and respiratory symptoms. Forty-two of the 73 patients (58{\%}) overall and 36 of the 54 patients (67{\%}) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission. The presence of radiographic abnormalities was significantly associated with dyspnea and oxygen/ ventilatory support requirements (P<0.01) and with day 28 mortality (45{\%} vs 13{\%}, P=0.005) but not with monocytic subtype of AML. Sixteen patients had isolated focal basilar airspace opacities, unilateral (n=13) or bilateral (n=3), while 16 patients had bilateral diffuse opacities, interstitial (n=12) or airspace and interstitial (n=4). Two patients had isolated pleural effusion, 2 patients had unilateral midlung airspace opacities, and 6 patients had a combination of focal airspace and diffuse interstitial opacities. Overall, 2 patterns accounted for 75{\%} of abnormal findings: bilateral diffuse opacities tended to be associated with monocytic AML, whereas basilar focal airspace opacities were more frequent in nonmonocytic AML (P<0.05). Eighteen patients had CT scans, revealing interlobular septal thickening (n=12), airspace (n=11) and ground-glass (n=9) opacities, pleural effusions (n=12), and acute pulmonary embolism (n=2). Hyperleukocytic AML is frequently associated with abnormal chest radiographs, involving mostly focal basilar airspace opacities (more frequent in nonmonocytic AML) or diffuse bilateral opacities. CT scan should be considered broadly due to the suboptimal resolution of radiographs for detecting signs of leukostasis.",
author = "Michael Stefanski and Carlos Jamis-Dow and Michael Bayerl and Desai, {Ruchi J.} and Claxton, {David F.} and {Van De Louw}, Andry",
year = "2016",
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language = "English (US)",
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journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
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T1 - Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia A retrospective cohort study of 73 patients

AU - Stefanski, Michael

AU - Jamis-Dow, Carlos

AU - Bayerl, Michael

AU - Desai, Ruchi J.

AU - Claxton, David F.

AU - Van De Louw, Andry

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Hyperleukocytic acute myeloid leukemia (AML) is associated with pulmonary complications and high early mortality rate, but given its rarity, data on chest radiographic presentation are scarce. We retrospectively reviewed the charts of 73 AML patients admitted with white blood cell count >100-109/L between 2003 and 2014 in order to describe the chest radiographic and computed tomography (CT) findings and to correlate them with AML subtype and respiratory symptoms. Forty-two of the 73 patients (58%) overall and 36 of the 54 patients (67%) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission. The presence of radiographic abnormalities was significantly associated with dyspnea and oxygen/ ventilatory support requirements (P<0.01) and with day 28 mortality (45% vs 13%, P=0.005) but not with monocytic subtype of AML. Sixteen patients had isolated focal basilar airspace opacities, unilateral (n=13) or bilateral (n=3), while 16 patients had bilateral diffuse opacities, interstitial (n=12) or airspace and interstitial (n=4). Two patients had isolated pleural effusion, 2 patients had unilateral midlung airspace opacities, and 6 patients had a combination of focal airspace and diffuse interstitial opacities. Overall, 2 patterns accounted for 75% of abnormal findings: bilateral diffuse opacities tended to be associated with monocytic AML, whereas basilar focal airspace opacities were more frequent in nonmonocytic AML (P<0.05). Eighteen patients had CT scans, revealing interlobular septal thickening (n=12), airspace (n=11) and ground-glass (n=9) opacities, pleural effusions (n=12), and acute pulmonary embolism (n=2). Hyperleukocytic AML is frequently associated with abnormal chest radiographs, involving mostly focal basilar airspace opacities (more frequent in nonmonocytic AML) or diffuse bilateral opacities. CT scan should be considered broadly due to the suboptimal resolution of radiographs for detecting signs of leukostasis.

AB - Hyperleukocytic acute myeloid leukemia (AML) is associated with pulmonary complications and high early mortality rate, but given its rarity, data on chest radiographic presentation are scarce. We retrospectively reviewed the charts of 73 AML patients admitted with white blood cell count >100-109/L between 2003 and 2014 in order to describe the chest radiographic and computed tomography (CT) findings and to correlate them with AML subtype and respiratory symptoms. Forty-two of the 73 patients (58%) overall and 36 of the 54 patients (67%) with clinical signs of pulmonary leukostasis had abnormal radiographs on admission. The presence of radiographic abnormalities was significantly associated with dyspnea and oxygen/ ventilatory support requirements (P<0.01) and with day 28 mortality (45% vs 13%, P=0.005) but not with monocytic subtype of AML. Sixteen patients had isolated focal basilar airspace opacities, unilateral (n=13) or bilateral (n=3), while 16 patients had bilateral diffuse opacities, interstitial (n=12) or airspace and interstitial (n=4). Two patients had isolated pleural effusion, 2 patients had unilateral midlung airspace opacities, and 6 patients had a combination of focal airspace and diffuse interstitial opacities. Overall, 2 patterns accounted for 75% of abnormal findings: bilateral diffuse opacities tended to be associated with monocytic AML, whereas basilar focal airspace opacities were more frequent in nonmonocytic AML (P<0.05). Eighteen patients had CT scans, revealing interlobular septal thickening (n=12), airspace (n=11) and ground-glass (n=9) opacities, pleural effusions (n=12), and acute pulmonary embolism (n=2). Hyperleukocytic AML is frequently associated with abnormal chest radiographs, involving mostly focal basilar airspace opacities (more frequent in nonmonocytic AML) or diffuse bilateral opacities. CT scan should be considered broadly due to the suboptimal resolution of radiographs for detecting signs of leukostasis.

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