For the past 3 years we preformed chest CT among 20 patients with known hematological malignancies, due to respiratory symptoms or for follow up. 13 patients had positive chest CT findings. There were 7 males and 6 females, the average age at the time of examination was 50,9±14,2. We analyzed the presence of nodular lesion, consolidation, cavitation, ground-glass lesion, interstitial thickening, lymphadenopathy and pleural involvement (effusion and pleural masses) (Table 1).
CT findings |
Number of patients |
Nodular lesion |
5 |
Consolidation |
7 |
Cavitation |
4 |
Ground-glass lesion |
6 |
Interstitial thickening |
4 |
Lymphadenopathy |
8 |
Pleural involvement (effusion and pleural masses) |
7 |
Table 1 : CT findings
These findings, along with history, clinical presentation and non invasive and invasive tests were classified into four PC groups. (Fig. 6)
We had 9 patients with leukemia, 3 of them had malignant complication, with the characteristic MDCT findings such as consolidation and activation of axial interstitium. (Fig 7).
Fig. 7: Leukemic pulmonary infiltration. Chest x-ray depicts bilateral inflitrates in upper and lower lobes (a.), whereas CT shows diffuse of consolidative masses in peribronchial area (b. and c.), and thickening of axial interstitium (d.).
5 patients had infectious complication, 3 had aspergillosis, with characteristic finding of multiple consolidation sourounded by ground glass opacities, forming patognomonic “hallo“ sign, and later consolidation developed necrosis and cavitation with characteristic „crescent“ sign. (Fig 8.)
Fig. 8: Aspergillosis. CT images depict multiple consolidations sourounded by ground glass opacities forming patognomonic "hallo" sign, (a. and b.). After two weeks, consolidations developed necrosis and cavitation with characteristic "crescent sign". ( c. and d.)
2 had bacterial infection with cavitation and limphadnopathy as dominant sign, and one patient had miscellaneous such as alveolar proteinosis with characteristic „crazy paving“ sign ( Fig. 9).
Fig. 9: Alveolar proteinosis. Chest X-ray depicts bilateral patchy infiltrates in upper and middle lobes (a.), whereas CT images ( b. - d.) depict ground-glass opacities permeated by septal interstitium forming pathognomonic “crazy paving” sign.
3 patients had lymphoma, 2 of them had infectious complication, and one had malignant complicaton wich was manifested as lymphadeopathy, peribronchovascular consolidiations, ground glass lesions and thickening of axial interstitium. (Fig. 10)
Fig. 10: Primary lung limphoma. Confluent mediastinal lymphadenopathy in all groups (a.) followed by bilateral consolidations along bronchovascular bundle (b.). Zones of ground-glass opacities and thickening of axial and septal interstitium, accompanied by pleural effusions (c. and d.).
One patient with multiple myeloma had combination of malignant and infectious complication with MDCT findings of interstital thickening and conslidation followed with bilateral lymphadenopathy ( Fig. 11).
Fig. 11: Multiple myeloma. CT images depict consolidaton (a.), thickening of axial interstitium (b.), bilateral mediastinal limphadenopathy (c.), ground-glass lesions in peribronhovascular distribution (b. and d.) and bone metastasis (e.).