In a retrospective review of 141 consecutive adult patients with acute leukaemia there were 33 local and eight diffuse parenchymal pulmonary abnormalities noted on the first abnormal chest radiograph. Empirical treatment was given without any invasive diagnostic procedures. Twenty of the 41 patients (49%) with radiographic abnormalities died--10 of 31 patients (32%) in the "local" group (excluding two who were not actively treated) and all eight patients in the "diffuse" group. One patient in the local group and six in the diffuse group died within 48 hours of the first abnormal chest radiograph. The results in the local group suggest that failure to respond to the initial treatment prescribed would allow time to perform an invasive procedure in most patients that may lead to a change in management. In the diffuse group, however, an early invasive procedure would be required if the result were to have a chance to influence the outcome.
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