Lung Mass With Crazy-Paving: An Unusual Initial Presentation of Acute Myeloid Leukaemia

Acute myeloid leukaemia is known to present non-specifically and more commonly with B symptoms. We report an interesting presentation of acute myeloid leukaemia as a lung mass which initially raised clinical suspicion of primary lung cancer. A gentleman in his 50s who is an active smoker presented with chronic cough, lethargy, and giddiness for 2 months. Physical examination revealed pallor, cervical lymphadenopathy, and bronchial breathing over the right middle zone on auscultation. CT thorax showed a spiculated solid mass with a crazy-paving pattern, suggestive of lung cancer. However, blood workup showed pancytopenia with a full blood picture showing 60% blast cells. Subsequent bone marrow examination confirmed the diagnosis of AML. The patient received 2-weekly venetoclax-based chemotherapy. Serial follow-up CT showed resolution of lung changes and the patient remained in remission.