Leukemic Involvement in the Thorax

Girish S. Shroff , Mylene T. Truong, Brett W. Carter, Marcelo F. Benveniste, Rashmi Kanagal-Shamanna, Greg Rauch, Chitra Viswanathan, Prajwal C. Boddu, Naval Daver, Carol C. Wu

Author Affiliations

• From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030.
• Address correspondence to G.S.S. (e-mail: gshroff@mdanderson.org).

Published Online:Jan 8 2019https://doi.org/10.1148/rg.2019180069

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Abstract

The authors review the major types of leukemia; describe the intrathoracic imaging manifestations of leukemia, with emphasis on complications that are directly related to leukemia; and discuss the role of PET/CT in detection of leukemia.

Leukemias are malignancies in which abnormal white blood cells are produced in the bone marrow, resulting in compromise of normal bone marrow hematopoiesis and subsequent cytopenias. Leukemias are classified as myeloid or lymphoid depending on the type of abnormal cells produced and as acute or chronic according to cellular maturity. The four major types of leukemia are acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and chronic lymphocytic leukemia. Clinical manifestations are due to either bone marrow suppression (anemia, thrombocytopenia, or neutropenia) or leukemic organ infiltration. Imaging manifestations of leukemia in the thorax are myriad. While lymphadenopathy is the most common manifestation of intrathoracic leukemia, leukemia may also involve the lungs, pleura, heart, and bones and soft tissues. Myeloid sarcomas occur in 5%–7% of patients with acute myeloid leukemia and represent masses of myeloid blast cells in an extramedullary location.