Intrathoracic manifestations of hematologic malignancies: a narrative review

Although the global incidence of hematologic malignancies is decreasing, the risk of developing these cancers is increasing due to increased lifespan and modern treatments including targeted therapy, chemotherapy, and radiation. Intrathoracic manifestations of hematologic malignancies may be the presenting sign leading to diagnosis or result from various treatment toxicity. The most common respiratory manifestation of hematologic malignancies is infectious, but up to half of pulmonary findings are from non-infectious etiologies. We aim to summarize the current literature on non-infectious intrathoracic manifestations of hematologic malignancies and their treatment.

We performed a literature review using PubMed Central and Google Scholar for articles published between January 1^st, 2014, and January 1^st, 2024. We used medical subject heading terms to search titles, abstracts, and diagnoses. We reviewed textbook chapters, literature reviews, practice guidelines, randomized controlled trials, and retrospective articles.

There are many pulmonary manifestations of hematologic malignancies. Lymphadenopathy and disease of serosal membranes are common. Pleural effusions can be malignant or related to treatment, and interventions include serial thoracentesis or indwelling pleural catheters (IPCs). Parenchymal diseases consist of primary pulmonary lymphoma, leukemic pulmonary infiltration, myeloid sarcoma, pulmonary alveolar proteinosis, and leukemic cell lysis pneumopathy. Endobronchial disease is rare. Pulmonary vascular disorders involve leukostasis, thromboembolic disease, pulmonary hypertension (PH), superior vena cava (SVC) syndrome, and pseudohypoxemia. Therapy-related sequelae may also occur.

Intrathoracic manifestations of hematologic malignancies should be considered in the differential diagnosis at the time of presentation since their management differs substantively.