title: Radiologic features of all-trans-retinoic acid syndrome.
abstract: 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.
authors.affiliation: Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 62 Yeouidodong, Youngdungpo-gu, Seoul 150-713, South Korea.
authors.forename: Jung Im
authors.initials: JI
authors.lastname: Jung
authors.forename: Jung Eun
authors.initials: JE
authors.lastname: Choi
authors.forename: Seong Tai
authors.initials: ST
authors.lastname: Hahn
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Chun Choo
authors.initials: CC
authors.lastname: Kim
authors.forename: Seog Hee
authors.initials: SH
authors.lastname: Park
mesh_terms: 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
chemical_list: D000970:Antineoplastic Agents; D014212:Tretinoin