2nd CXR obtained 6 days later. Patient was found to have acute promyelocytic leukemia APL & started treated with ATRA 2 days before this xray. Despite Rx for patients CHF symptoms progressed.
There is interval worsening of bilateral airspace disease compared to prior study. There is persistent mild pulmonary vascular congestion and likely small bilateral pleural effusions.
Differential considerations include CHF exacerbation, pneumonia, aspiration, acute respiratory distress syndrome, or given recent history of all-trans retinoic acid (ATRA) therapy, Differentiation syndrome (otherwise known as ATRA syndrome) can not be excluded.
Right arm PICC line, with tip in the right axillary vein.