Background <p>Pulmonary complications are common and serious challenge in patients with hematological diseases, contributing to morbidity and mortality. While chest imaging is critical for early detection and characterization, this area remains underexplored in original research.</p> Methods <p>This is a retrospective observational study involving patients records in the Clinical Hematology Unit. A total of 1,934 hematology inpatients (April 2020–December 2023) were screened; 253 had pulmonary symptoms. After excluding 105 cases due to incomplete data or early mortality before workup completion, 148 patients were included in the analysis. Clinical, laboratory, and radiological data were analyzed. Patients were grouped by hematologic diagnosis (malignant and non-malignant) and 30-day outcome (recovered and died). The study protocol was approved by the Faculty of Medicine’s Research Ethics Medical Review Board at Assiut University under approval number IRB 04-2024-300373.</p> Results <p>Lobar pneumonia was the most frequent radiological pattern, with bacterial pneumonia being the commonest across both hematologic groups. Adult Respiratory Distress Syndrome (ARDS), pneumonia, and pleural effusion were significantly associated with higher 30-day mortality. ARDS demonstrated the strongest predictor of mortality.</p> Conclusion <p>Bacterial lobar pneumonia was the predominant pulmonary complication in hematological patients. The presence of ARDS, pneumonia, or pleural effusion had a significant association with early mortality, with ARDS being the strongest predictor, emphasizing the importance of early diagnosis and management.</p> Trial registration <p>ClinicalTrials.gov ID: NCT06350526, Registration date: 2^nd January 2024.</p>