Miliary tuberculosis

Case contributed by Oliver Hennessy
Diagnosis almost certain


HIV positive. Chronic cough

Patient Data

Age: 46
Gender: Male

Frontal radiograph shows randomly distributed nodules throughout both lungs. In addition there is right middle lobe consolidation and a right pleural effusion.


CT show miliary nodules in both lungs. The nodules are distributed in a random manner.

There is right middle lobe consolidation and a right pleural effusion

Case Discussion

When reviewing a case of miliary nodules the important issues are:

  • clinical presentation and detailed relevant medical history, e.g., history of silicosis, drug and substance abuse usage, ethnicity and immune status, previous history of malignancy.
  • location of nodules, i.e. centrilobular, perilymphatic or random in location
  • zonal distribution of the nodules, areas of relative sparing.
  • associated findings, i.e.  pulmonary fibrosis,  ground glass opacification, mediastinal nodes, if present are the nodes calcified, pleural effusion
  • previous imaging if available can be most helpful, the answer may lie within the patient's imaging folder

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