case_images: PMC9949745_01
case_images: Chest radiograph at admission showing pleural effusion
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case_images: PMC9949745_01_cureus-0015-00000034128-i01.jpg
case_images: FIG1
case_images: Pleural effusion was documented on the chest radiograph (Figure 1). 
case_images: Lung CT showing bilateral pleural effusion
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case_images: PMC9949745_01_cureus-0015-00000034128-i02.jpg
case_images: FIG2
case_images: A whole-body CT scan showed bilateral pleural effusion (Figure 2), mediastinal and hilar adenopathy, hepatomegaly, and ascites (Figure 3).
case_images: Abdominal CT scan showing hepatomegaly and ascites
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case_images: PMC9949745_01_cureus-0015-00000034128-i03.jpg
case_images: FIG3
case_images: A whole-body CT scan showed bilateral pleural effusion (Figure 2), mediastinal and hilar adenopathy, hepatomegaly, and ascites (Figure 3).
case_images: Positron emission tomography (PET) scan showing discrete metabolic activity in the bone marrow
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case_images: PMC9949745_01_cureus-0015-00000034128-i04.jpg
case_images: FIG4
case_images: A positron emission tomography (PET) scan revealed discrete metabolic activity in the bone marrow (Figure 4), compatible with the bone marrow biopsy findings (Figure 5). 
case_images: Microscopic examination of the bone marrow . Seen is a moderately increased cellularity due to lymphoid cell proliferation with a sheet pattern (A). The lymphoid cells had round nuclei with irregular nuclear membranes, dense chromatin, and scarce cytoplasm (B). In the histochemical study, these cells showed diffuse immunoreactivity for the cluster of differentiation (CD)79a (C) with co-expression of CD5 (D) and CD23 (E), compatible with infiltration by chronic lymphocytic leukemia (CLL).. Photos courtesy of Dr. Tiago Oliveira (Hospital de Santa Maria, CHULN, Lisbon, Portugal)
case_images: cureus-0015-00000034128-i05.jpg
case_images: PMC9949745_01_cureus-0015-00000034128-i05.jpg
case_images: FIG5
case_images: A positron emission tomography (PET) scan revealed discrete metabolic activity in the bone marrow (Figure 4), compatible with the bone marrow biopsy findings (Figure 5). 
case_images: Microscopic analysis of the liver biopsy shows mild macro and microvacuolar steatosis and moderate perisinusoidal fibrosis (A), as well as sinusoidal infiltration by small lymphoid cells (B), identical to the ones observed in the bone marrow with the same diffuse immunoreactivity for the cluster of differentiation (CD)79a. . Photos courtesy of Dr. Tiago Oliveira (Hospital de Santa Maria, CHULN, Lisbon, Portugal).
case_images: cureus-0015-00000034128-i06.jpg
case_images: PMC9949745_01_cureus-0015-00000034128-i06.jpg
case_images: FIG6
case_images: In addition, a transjugular liver biopsy was performed, and leukemic infiltration of the liver was documented, confirming the diagnosis of CLL progression (Figure 6). 