Diffuse pulmonary alveolar hemorrhage in acute promyelocytic leukemia

A 60-year-old male with acute promyelocytic leukemia demonstrated bilateral diffuse air-space consolidation on chest X-ray. An autopsy on the next day revealed pure pulmonary alveolar hemorrhage without leukemic infiltration or inflammation. Disseminated intravascular coagulation was confirmed microscopically. In severe hemorrhagic diathesis and leukopenia, it is impossible to distinguish pulmonary hemorrhage from pneumonia by X-ray alone. Bronchalveolar lavage may be the only possible diagnostic approach.