Chest radiographic-pathologic correlation in adult leukemia patients

A radiographic-pathologic correlation study of adult leukemia patients was conducted to determine the frequency and radiographic appearance of leukemic involvement and related complications within the chest. One hundred thirteen autopsy protocols were examined. Radiographic correlation was obtained in 60 of these cases. Autopsy pulmonary findings included hemorrhage in 74% of the cases, infectious infiltrates in 67%, edema or congestion in 57%, and leukemic infiltration in 26%. Only 5% of the chest radiographs were normal. Alveolar or interstitial abnormalities were identified in 90%, pleural effusion in 40%, and lymphadenopathy in 17%. Correlation demonstrated pulmonary infection to be by far the most common cause of radiographic opacity. Because of its frequent occurrence, high associated mortality, and potential reversibility, pneumonia must always be considered first in the differential diagnosis of radiographic opacity in these patients.