Background. Leukemic pulmonary infiltration (LPI) is one of the pulmonary complications of chronic lymphocytic leukemia (CLL). However, it can be difficult to make a differential diagnosis based only on imaging findings. Case. A 66-year-old man had been given a diagnosis of CLL. Chest CT scan showed nodular opacity in the left lower lobe during follow-up of CLL. We performed CT-guided percutaneous lung biopsy and diagnosed LPI. Two years later, chest CT newly showed infiltrative shadows and ground glass opacities around the same site at which LPI developed. We performed bronchoscopy and observed protruding lesions spread to the tracheal and the bronchial mucosa. We diagnosed recurrence of LPI complicated with tracheobronchial involvement. These lesions disappeared following chemotherapy with ofatumumab. Conclusion. When imaging findings showed abnormal pulmonary shadows during follow-up for CLL, pathological examination was useful for making a diagnosis and treatment.