The introduction of X-ray computed tomography into practice, especially of high resolution, significantly improves the diagnosis of pulmonary manifestations of CLL. In 102 patients with CLL, chest CT was performed (during the polar phases of respiration, planimetric and densitometric measurements), pathology was detected in 85 patients (83%), radiographs and linear tomograms changes were detected only in 46 patients (45%). At CT scan the following changes were revealed: root and mediastinal lymphadenopathy – in 68 (66.7%); compression of the bronchi and lung tissue by the lymph nodes with Richter syndrome – in 15 (14.7%); pneumonia – in 45 (44.1%); lymphoid infiltration of the lungs – in 5 (4.7%); lymphoid infiltration of the pleura – in 14 (13.7%); pleurisy – in 28 (27.5%); pulmonary tuberculosis – 10 (9.8%); emphysema – in 78 (76.5%); pneumosclerosis – in 37 (36.3%); post-pneumonic pneumofibrosis – in 14 (13.7%).
The enlarged lymph nodes of the mediastinum, according to different authors, I diagnose in 25-64% of patients with CLL . For the most part, peripheral lymph nodes are larger than the intrathoracic, but reverse relationships can also be observed. The severity of mediastinal lymphadenopathy depends on the stage of development of the tumor process. Lymphoadenopathy in patients with CLL is mainly peripheral. On this occasion, it is mainly patients who go to the doctor. Only a few of them at this time radiographically determine the enlargement of the lymph nodes of the median. Later, in the advanced stage of the disease, mediastinal lymphadenopathy is detected in more than half of the patients, sometimes reaching considerable sizes. However, for the classical course of the disease, even with a significant increase in lymph nodes, compression syndrome is not characteristic .