Hematologic neoplasms: Interpreting lung findings in chest computed tomography

Abstract

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.

Thoracic CT Scan Findings in Patients with Confirmed Hematologic Malignancies Admitted to the Hospital with Acute Pulmonary Symptoms

“…Consistent with the studies by Ahmad et al, Choi et al, and Bugdaci et al, pneumonia was the most common pulmonary manifestation in these patients (3,4,12). Calvillo Batllés et al also found infection to be the most common cause of pulmonary involvement in patients with hematologic neoplasms (16). Nema et al also showed that bacterial and fungal pneumonia were the main causes of lung lesions in patients with hematologic malignancies, whereas bacterial pneumonia and tuberculosis were the main causes in patients without hematologic malignancy (17).…”

“…a Considering the combination of clinical and paraclinical data, with the results of the CT scan cies in our study (16). In the study conducted by Kosichkina et al, the bacterial source was considered the most com-mon cause of pneumonia, which was significantly associated with the GGO pattern (13).…”

Frequency and predictors of occult cancer in ischemic stroke: A systematic review and meta-analysis

“…chest X-ray) in all subjects, with the exclusion of echocardiograms. 6 Statistical significance for heterogeneity and subgroup tests was defined as a p-value of <0.05. Reporting bias was explored by visual inspection of funnel plots, when at least 10 studies for a specific frequency measure were available.…”

Vieussens’ Arterial Ring: Historical Background, Medical Review and Novel Anatomical Classification

“…According to Chenjin Ge et al, the most frequent symptoms in patients with VAR fistulas were chest pain and dyspnoea [67]. We found that of the 13 CAF cases reported in the literature, five patients presented with angina [6,24,35,42,55], three with chest discomfort [25,36,37] and three with dyspnoea [25,28,46], whereas two were asymptomatic [10,31].…”

“…Probably, the pressure gradient, which is responsible for the VAR dilation, is the precipitating factor for the formation of VAR aneurysms. The present review includes 13 VAR aneurysm cases, three solitary [26,41,49] and 10 in concurrence with CAFs [10,22,25,28,31,[35][36][37]46,55]. With respect to the study cohort, 43% of the women (p = 0.011) presented with an aneurysm, compared to 14% of the men.…”