Miliary tuberculosis

Case contributed by Dr Mark Holland

Presentation

Generally unwell with lethargy, night sweats and hemoptysis.

Patient Data

Age: 20 years
Gender: Male
X-ray

Chest x-ray demonstrates very widespread randomly distributed innumerable tiny nodules in both lungs. There is no consolidation or pleural fluid and no mediastinal or hilar nodal enlargement. 

Diagram

Zoomed cropped image from the left upper zone demonstrates innumerable well defined ~2mm nodules.

Milet seeds. Photo credit: Elke Wetzig Original file: http://en.wikipedia.org/wiki/File:Hirsekoerner.jpg Licence: CC-SA-BY

Case Discussion

This patient has presented with constitutional symptoms and an abnormal chest radiograph with multiple, well-defined, tiny (2 mm) nodules throughout both lungs with no zonal predilection. By far the most likely diagnosis here is of tuberculosis, which was subsequently confirmed. 

Miliary tuberculosis represents hematogenous spread of uncontrolled TB infection.

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