The rapid growth of lymph nodes, their acquisition of stony density, compression and infiltration of neighboring organs and tissues, causing swelling and pain, are characteristic of sarcomas, malignant transformation of CLL – the so-called. Richter syndrome. At this stage of the disease, compression of the enlarged lymph nodes of the bronchi and lung tissue is possible, accompanied by impaired ventilation of the lungs and the drainage function of the bronchi. In the stage of malignant transformation, the germination of the lymph node tissue into the lung tissue and the lumen of the bronchi is possible, which is not typical for the classic course of CLL. For verification of Richter syndrome, a histological examination of sarcomotransformed lymph nodes is necessary. Operational biopsy is not difficult if the transformation occurs in the peripheral lymph nodes,and it is very difficult to defeat mediastinal or abdominal nodes. Without replacing the histological examination, CT can help in the diagnosis of sarcoma transformation. lymph nodes of the chest cavity. Development of a compression syndrome in the chest cavity, associated with enlarged lymph nodes and / or germination of the lymph node tissue into the surrounding tissues, favors the development of Richter syndrome . In patients with Richter syndrome due to impaired lung ventilation and drainage of the bronchi, infection of the bronchopulmonary system is a fairly common and very serious complication. But in addition to inflammatory infiltrates, in the stage of malignant transformation of CLL, specific leukemic infiltration may appear in the lungs, the differential diagnosis of which with inflammatory infiltrates is very difficult .

There are great prospects in the use of CT for the objectification of X-ray images and parameters characterizing the selective status of the ventilation function of light . Radiographic findings on the state of pulmonary pattern and emphysema are very subjective . A.V. Lenshin (2004) developed a method for quantitative assessment of X-ray data on CT using the Hitachi W-800 computerized tomograph using the Level Detect program. The most optimal AV Lenshin considers sections at the level of the trachea bifurcation, made with a deep breath (the level of the pulmonary artery stem) [159]. Experienced by examining 100 healthy patients, 57 – with COPD and 54 – with bronchial asthma, the author found that in the density range –950 …- 1000 units. HU is detected (“contrasted”) with emphysematous transformed lung tissue.Counting the selected pixels in fixed (dominant) areas of a particular axial tomographic slice allows to obtain quantitative (in% per unit area) diagnostic tests of pulmonary emphysema [159]. This technique was used by us in patients with CLL (Fig. 9). In the studied groups of CLL patients, the following results of the quantitative determination of pulmonary emphysema were obtained: in group I, the percentage of emphysematous tissue per unit. the average area was 27.24 ± 0.24; in group II – 34.27 ± 0.31%; in group III – 42.29 ± 0.21%.the average area was 27.24 ± 0.24; in group II – 34.27 ± 0.31%; in group III – 42.29 ± 0.21%.the average area was 27.24 ± 0.24; in group II – 34.27 ± 0.31%; in group III – 42.29 ± 0.21%.