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Pulmonary leukostasis mimicking pulmonary embolism
D A Kaminsky1, C G Hurwitz, J I Olmstead
1Pulmonary Disease and Critical Care Medicine, Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington 05405, USA. dkaminsk@zoo.uvm.edu
Leukemia Research
|February 2, 2000
Summary
Acute myelogenous leukemia with pulmonary leukostasis can mimic pulmonary embolism. This case underscores the importance of considering leukemia in patients with unexplained ventilation-perfusion scan abnormalities, as prompt diagnosis is critical.
Area of Science:
- Hematology
- Pulmonology
- Diagnostic Imaging
Background:
- Acute myelogenous leukemia (AML) with hyperleukocytosis can present with respiratory symptoms.
- Pulmonary leukostasis, a rare complication of AML, involves leukemic cell infiltration of pulmonary vasculature.
Observation:
- A 32-year-old woman presented with shortness of breath and pleuritic chest pain.
- Ventilation-perfusion (V/Q) scan showed perfusion defects suggestive of pulmonary embolism.
- Subsequent diagnosis revealed acute myelogenous leukemia with hyperleukocytosis and pulmonary leukostasis.
Findings:
- Autopsy confirmed extensive leukemic cell infiltration in multiple organs without evidence of pulmonary embolism.
- Pulmonary leukostasis presented with clinical and radiographic findings mimicking pulmonary embolism.
- Despite urgent leukopheresis, the patient unfortunately succumbed to the disease.
Implications:
- This case highlights the critical need to differentiate pulmonary leukostasis from pulmonary embolism in patients with AML.
- Clinicians should maintain a high index of suspicion for leukemic infiltration in V/Q scan abnormalities.
- Early recognition and appropriate management strategies are crucial for improving outcomes in pulmonary leukostasis.
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