Acute myeloid leukemia chest x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2], Carlos A Lopez, M.D. [3], Shyam Patel [4]; Grammar Reviewer: Natalie Harpenau, B.S.[5]


Chest x-ray is useful for the diagnosis and evaluation of various aspects of acute myeloid leukemia management, including differentiation syndrome, infection, volume overload, and venous catheter placement.

Chest X-ray

The indications for chest X-ray in acute myeloid leukemia include assessment for the following:

  • Differentiation syndrome: Chest radiography is useful in the assessment of differentiation syndrome, which is a therapy-related complication when patients are treated with all-trans retinoic acid, enasidenib, or ivosidenib.[1] Chest X-ray will show pulmonary infiltrate and/or edema.[2]
  • Infection: Chest x-ray is routinely employed if a lung infection is suspected.[3] Bacterial, viral, and fungal pneumonias are very common in patients with acute myeloid leukemia receiving chemotherapy. Bacterial pneumonia will present as lobar consolidations on chest X-ray. Viral pneumonia will present as interstitial or reticular opacities on chest X-ray. Fungal pneumonia will present as nodules on chest X-ray.
  • Volume overload : Patients with acute myeloid leukemia typically received greater than 10 liters of intravenous fluids during induction chemotherapy. This can result in volume overload if diuresis is not appropriately administered. The accumulation of excess fluids within the pulmonary alveoli can result in pulmonary edema, which is readily detected on a chest X-ray as blunted costophrenic angles and Kerley B lines.
  • Venous catheter placement: Confirmation of the location of central access (central venous catheters) is done by obtaining a chest X-ray. Since patients with acute myeloid leukemia receive systemic chemotherapy, they usually have a peripherally-inserted central catheter or port, for which the catheter tip should terminate in the sinoatrial junction. A chest X-ray is needed to confirm placement.


  1. Cardinale L, Asteggiano F, Moretti F, Torre F, Ulisciani S, Fava C; et al. (2014). "Pathophysiology, clinical features and radiological findings of differentiation syndrome/all-trans-retinoic acid syndrome". World J Radiol. 6 (8): 583–8. doi:10.4329/wjr.v6.i8.583. PMC 4147438. PMID 25170395.
  2. Xu LM, Zheng YJ, Wang Y, Yang Y, Cao FF, Peng B; et al. (2014). "Celastrol inhibits lung infiltration in differential syndrome animal models by reducing TNF-α and ICAM-1 levels while preserving differentiation in ATRA-induced acute promyelocytic leukemia cells". PLoS One. 9 (8): e105131. doi:10.1371/journal.pone.0105131. PMC 4130635. PMID 25116125.
  3. Andronikou S, Lambert E, Halton J, Hilder L, Crumley I, Lyttle MD; et al. (2017). "Guidelines for the use of chest radiographs in community-acquired pneumonia in children and adolescents". Pediatr Radiol. 47 (11): 1405–1411. doi:10.1007/s00247-017-3944-4. PMC 5608836. PMID 29043422.


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