Clinical, haematological, and radiological features in T-cell lymphoblastic malignancy in childhood

T-cell lymphoblastic malignancy in childhood includes both T-cell acute lymphoblastic leukemia (T-ALL) and non-Hodgkin's lymphoblastic lymphoma (T-NHL). There is considerable overlap between these disorders, which probably represent two ends of the same disease spectrum. To determine whether there are radiological differences between T-ALL and T-NHL we reviewed the clinical, haematological and radiological features of 58 children seen in one centre over a 9-year period. Splenomegaly and adenopathy were significantly more common in T-ALL than in T-NHL. Patients with T-ALL were usually anaemic and thrombocytopenic, with elevated white blood cell counts; patients with T-NHL had normal blood counts. The radiological abnormalities seen were mediastinal enlargement, pleural effusions, and tracheal compression. All patients with T-NHL had abnormal chest radiographs, whereas 10 of 39 patients with T-ALL had normal chest radiographs. When only abnormal radiographs were compared, however, there were no differences in the degree of mediastinal widening or in the size of pleural effusions. Tracheal compression was more common in T-NHL and was always most marked in the intrathoracic airway and in an antero-posterior direction. We conclude that there is little difference in the radiological abnormalities seen in T-ALL and T-NHL, which further supports the theory that they represent points along a common spectrum of disease. As airway compression is primarily intrathoracic and in an antero-posterior direction, adequate radiological evaluation should include a lateral chest radiograph.