However, the clinical manifestations of compression syndrome in the chest cavity (shortness of breath, asphyxiation, cough, pain syndrome) were diagnosed only in 5 people with Richter syndrome. In 6 patients, the spleen occupied a large part of the abdominal cavity (splenic form of CLL); radiologically, these patients were diagnosed with a high standing of the diaphragm dome. In the terminal stage of the disease, such a spleen caused compression syndrome in the abdominal cavity, chest compression was observed, which was clinically manifested by shortness of breath. In 12 patients in the terminal stage of the disease, with a significant increase in the liver and spleen, which had a dense consistency, insufficiency of blood circulation developed. Clinically, this was manifested by the accumulation of fluid in the pleural cavities (transudate), shortness of breath, cough, ascites, edema in the lower extremities.In the presence of fluid in the pleural cavities, a significant weakening of breathing and voice tremor was determined over the zone of lesion of the pleura, dull pulmonary sound. In 6 patients in the lower parts of the lungs, moist rales were heard.
In 21 patients of group III (9.2%), in the terminal stage of the disease, a specific lymphoproliferative pleurisy was diagnosed as a manifestation of leukemic pleural infiltration. In the presence of initial manifestations of lymphoproliferative pleurisy, clinical symptoms were absent. As it progressed, clinical symptoms appeared: dyspnea (19 patients), weight loss (21 patients), anorexia (21 patients), fever (10 patients). Only 9 patients with lymphoproliferative pleurisy experienced chest pain; they characterized the pain as dull and aching. During auscultation of the lungs in such patients, a significant weakening of respiration was determined over the area of pleural lesion, percussion – a dulling of pulmonary sound, and a weakening or strengthening of voice jitter was determined.When a large amount of exudate accumulated in the pleural cavity, a lag of the affected lung was noted during breathing.
Infectious complications occur from 75 to 80% in patients with CLL . As CLL progresses, the incidence of bacterial and viral infections increases . Specific lymphoid infiltration of the lung tissue and hyperplasia of the lymphoid follicles of the bronchial tree contribute to bronchopulmonary complications in CLL. All this leads to the development of atelectasis, impaired ventilation and gas exchange function of the lungs and the drainage function of the bronchi . At the same time, the lifetime diagnosis of leukemic infiltration with the use of rontgenological methods causes considerable difficulties. . The source of infiltration is lymphoid follicles located around the bronchi and large veins. In the phase of malignant transformation of CLL, the tumor can grow from the lymph nodes into the fatty tissue of the mediastinum, the lesion of the interalveolar septa of the lung, the wall of the bronchi and pleura .
Of course, one of the main methods for recording the prevalence of the tumor process in CLL is renn-tomography and tomography . As an example, we present one of the observations . Patient V., 62 years old. On the radiograph of the organs of the thoracic cavity in a direct projection (Fig. A), bilateral, moderately pronounced root lymphadenopathy is determined without infiltrative changes in the lung tissue. When the sighting ERTG determined specific lymphoid infiltration of the lung tissue, muftoobrazno covering the upper lobe bronchus and circularly narrows their Enlightenment Russian you . On the radiograph, these changes are not differentiated.
If we summarize the available information in the literature and our own experience, then it can be noted that radiologically much more often we have to diagnose complications of leukemia in the form of various kinds of pneumonia than the actual leukemic infiltrates. Specific leukemic infiltrates with traditional radiography are rarely diagnosed, because they do not reach significant sizes. With significant leukemic infiltration of the peribronchial tissues, it is possible to note a pronounced increase in the pulmonary pattern and its deformation, corresponding to the delicate mesh -looped structure .
As the process progresses against this background, small focal shadows appear, the anatomical substrate of which can be both specific and non-specific processes in the lungs. Focal shadows in some cases can be a display of peribronchial and perivascular couplings in their cross section. With a friend On the other hand, specific leukemic infiltrates that go to the alveoli and perform them form small foci, which can be radiologically similar in the form of foci. Concomitant pneumonia, among which quite often small-focal forms occur, is also sometimes an anatomical substrate of small focal-like shadows. X-ray manifestations of specific leukemic infiltration and the accompanying or self-induced pneumonia may be similar. This similarity is so pronounced that it is difficult to decide which elements of the shadow pattern are associated with inflammatory changes, which are caused by specific infiltration, even with the use of modern technology – CT and ERTG.