Abstract
the periaortic area and localized hyper echogenity was observed in the paravalvular region. Left and right atrial dimension and pulmonary artery systolic pressure were increased. The analysis of thoracentesis material revealed Ph+ cells and flow cytometry confirmed blastic transformation. As the bone marrow analysis was still in hematological and molecular remission the final diagnosis was extramedullary blastic transformation of CML presenting with pleura-pericardial involvement. An acute leukemia induction treatment with tyrosine kinase inhibitor initiated, complicated with bacterial and fungal infections. He recovered in remission. The pleura-pericardial effusion dissolved completely. The underlying arrhythmias disappeared. Chest CT and echocardigraphic control exam showed us complete recovery of left and right ventricular wall motions, and normalization of both atrium dimensions. Conclusion: This is a rare case of extramedullary blastic transformation of CML, who had received allo HSCT. The pleura-pericardial effusion which disappeared completely after chemotherapy and TKI, and resolution of underlying arrhythmias and cardiac insufficiency was demonstrative for the efficient treatment of extramedullary CML relapse.
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