Pulmonary leukostasis mimicking pulmonary embolism

Kaminsky, David A.; Hurwitz, Craig G.; Olmstead, Jennifer I.

doi:10.1016/s0145-2126(99)00162-9

Cited by 20 publications

(9 citation statements)

References 13 publications

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“…Chest X‐ray (CXR) may be normal or show the alveolar pattern of infiltrates . Furthermore, pulmonary leukostasis can radiologically mimic tuberculosis and pulmonary embolism in the appropriate clinical setting . In the vast majority of cases, respiratory symptoms of leukostasis present before the leukemia targeted treatment is initiated, although rare patients may worsen after initiation of induction chemotherapy .…”

Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest

Ali

Mirrakhimov

Abboud

et al. 2016

Hematological Oncology

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Leukostasis is a poorly understood and life-threatening complication of acute hyperleukocytic leukemia. The incidence of hyperleukocytosis and leukostasis differs among various subtypes of leukemias. While the pathophysiology of leukostasis is not fully understood, recent research has elucidated many novel pathways that may have therapeutic implications in the future. Respiratory and neurological compromise represents the classical clinical manifestations of leukostasis. If it is not diagnosed and treated rapidly, the one-week mortality rate is approximately 40%. Targeted induction chemotherapy is an important component of the successful treatment of leukostasis, although other modalities of cytoreduction are being used and investigated.

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Section: Clinical Presentation and Diagnosismentioning

confidence: 99%

Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest

Ali

Mirrakhimov

Abboud

et al. 2016

Hematological Oncology

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“…Automated laboratory equipment may underestimate the degree of thrombocytopenia, counting WBC fragments as platelets (18). Leukostasis that presents in a patient with undiagnosed leukemia can mimic other conditions such as pulmonary embolism, pneumonia, cerebral vascular accidents, sepsis, Rocky Mountain spotted fever, thrombotic thrombocytopenic purpura, or vasculitis (19).…”

Section: Patient Presentationmentioning

confidence: 99%

Cerebral Hemorrhage Due to Hyperleukocytosis

Shiber¹

2011

The Journal of Emergency Medicine

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“…Although all patients had leukostasis and vascular occlusions, those with normal radiographs had macroscopically normal lungs on autopsy while the others had edematous lungs, suggesting that leukostasis may coexist with pulmonary edema/hemorrhage. Case reports of hyperleukocytic myeloid leukemias with pulmonary leukostasis, minor radiographic findings, and perfusion defects on ventilation–perfusion scans were also described, [ 11 , 17 ] highlighting the role of vascular occlusion by leukemic cells in the pathogenesis of leukostasis. [ 13 ] In agreement with these studies, we observed a variety of radiographic abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…First, hyperleukocytosis may affect blood rheology by causing mechanical vessel obstruction and hyperviscosity; this rheological model explains why patients with autopsy-proven pulmonary leukostasis may present with normal chest radiographs [ 10 ] or perfusion defects on ventilation–perfusion scan mimicking pulmonary embolism. [ 11 ] However, the lack of clear correlation between WBC count and the incidence and severity of leukostasis suggests that additional mechanisms are also involved: leukemic cells have the ability to release cytokines (tumor necrosis factor-α [TNF-α] and interleukin-1) and induce their own adhesion on the endothelial surface, with subsequent cytokine-driven increased endothelial permeability, pulmonary edema and hemorrhage, and finally interstitial invasion by leukemic cells. [ 1 ] These mechanisms likely account for the diffuse airspace opacities and pleural effusion reported in other patients.…”

Section: Introductionmentioning

confidence: 99%

Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia

Stefanski

Jamis‐Dow²,

Bayerl³

et al. 2016

Medicine

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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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Pulmonary leukostasis mimicking pulmonary embolism

Cited by 20 publications

References 13 publications

Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest

Leukostasis in adult acute hyperleukocytic leukemia: a clinician's digest

Cerebral Hemorrhage Due to Hyperleukocytosis

Chest radiographic and CT findings in hyperleukocytic acute myeloid leukemia

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