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Leukemic pulmonary infiltration is underrecognized and radiologically heterogeneous. A 64\u2010year\u2010old man with CLL developed dyspnea, cough, and bilateral basal crazy\u2010paving opacities on high\u2010resolution computed tomography. Bronchoalveolar lavage showed lymphocytosis and a CD5\u2010positive monoclonal B\u2010cell population. Transbronchial lung cryobiopsy supported CLL infiltration and argued against mantle\u2010cell lymphoma or transformation. Obinutuzumab plus venetoclax was followed by clinical improvement and regression of the interstitial lung opacities on follow\u2010up imaging. This case supports combining BAL flow cytometry with tissue confirmation in this unusual pulmonary presentation.<\/jats:p>\n                  <jats:p>Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.<\/jats:p>","DOI":"10.1002\/jha2.70430","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T12:31:11Z","timestamp":1792585871000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Involvement in Chronic Lymphocytic Leukemia: A Structured Diagnostic Approach to Diffuse Infiltrates\u2010A Case Report"],"prefix":"10.1002","volume":"7","author":[{"given":"Benoit","family":"Aguado","sequence":"first","affiliation":[{"name":"Department of Respiratory Medicine Limoges University Hospital University of Limoges  Limoges France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florent","family":"Favard","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Limoges University Hospital University of Limoges  Limoges France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Egenod","sequence":"additional","affiliation":[{"name":"Department of Respiratory Medicine Limoges University Hospital University of Limoges  Limoges France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro De Lima","family":"Prata","sequence":"additional","affiliation":[{"name":"Department of Hematology and Cellular Therapy University Hospital of Limoges  Limoges France"},{"name":"Reference Center for Primary Amyloidosis and Other Immunoglobulin Deposition Diseases University Hospital of Limoges  Limoges France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaud","family":"Jaccard","sequence":"additional","affiliation":[{"name":"Department of Hematology and Cellular Therapy University Hospital of Limoges  Limoges France"},{"name":"Reference Center for Primary Amyloidosis and Other Immunoglobulin Deposition Diseases University Hospital of Limoges  Limoges France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2017.02.006"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11736"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resinv.2023.12.011"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003300101013"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.rmcr.2018.10.011","article-title":"Direct Pulmonary Infiltrates as an Initial Manifestation of Chronic Lymphocytic Leukemia","volume":"25","author":"Fukada A.","year":"2018","journal-title":"Respiratory Medicine Case Reports"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005382\u2010200605000\u201000009"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1148\/rg.236035101"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1007\/s13244-010-0060-5","article-title":"The Crazy\u2010Paving Pattern: A Radiological\u2010Pathological Correlation","volume":"2","author":"De Wever W.","year":"2011","journal-title":"Insights Imaging"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40248\u2010017\u20100107\u20102"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2011.623252"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clml.2018.11.005"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00277\u2010004\u20100876\u20105"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00425\u20102022"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1183\/09059180.00008812"},{"key":"e_1_2_13_16_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.rmcr.2024.102038","article-title":"Venetoclax\u2010Associated Interstitial Pneumonitis","volume":"50","author":"Siddiqui A. 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