Radiologic features of all-trans-retinoic acid syndrome.
OBJECTIVE
The treatment of acute promyelocytic leukemia with all-trans-retinoic acid (ATRA) sometimes results in a syndrome characterized by fever, respiratory distress, weight gain, pleural and pericardial effusion, and pulmonary infiltrates. We report the radiologic features of ATRA syndrome.


METHODS
During the past 5 years, 69 patients with acute promyelocytic leukemia were treated with ATRA. Of this group, 15 patients developed ATRA syndrome. Serial chest radiographs of the 15 patients with ATRA syndrome were evaluated retrospectively for the presence of pleural effusion, pulmonary nodules, consolidation, ground-glass opacity, septal lines, increased pulmonary blood volume, peribronchial cuffing, and air bronchogram. Also, we measured the cardiothoracic ratio and the vascular pedicle width.


RESULTS
Chest radiographs showed increased cardiothoracic ratio in 13 of the 15 patients, increased vascular pedicle width in 13, increased pulmonary blood volume in 13, septal lines in nine, peribronchial cuffing in nine, ground-glass opacity in nine, consolidation in seven, and nodules in seven. Pleural effusion was noted in 11 of the 15 patients, and air bronchogram was noted in five of the 15 patients. Pulmonary hemorrhage developed in three patients who were being treated with ATRA; they showed bilateral, diffuse, poorly defined nodules and ground-glass opacity on radiography.


CONCLUSIONS
Most patients with ATRA syndrome have abnormal findings on chest radiographs, and the abnormalities are similar to those of pulmonary edema.
Jung
Jung Im
JI
Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouidodong, Youngdungpo-gu, Seoul 150-713, South Korea.
Choi
Jung Eun
JE
Hahn
Seong Tai
ST
Min
Chang Ki
CK
Kim
Chun Choo
CC
Park
Seog Hee
SH
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D008171:Lung Diseases / Q000139:chemically induced / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000139:chemically induced / Q000000981:diagnostic imaging*; D010996:Pleural Effusion / Q000139:chemically induced / Q000000981:diagnostic imaging*; D011859:Radiography; D013577:Syndrome; D014212:Tretinoin / Q000009:adverse effects*; D015430:Weight Gain
D000970:Antineoplastic Agents; D014212:Tretinoin