Scroll through the images on the left. Radiographics. References. Patients with post-primary pulmonary tuberculosis are often asymptomatic or have only minor symptoms, such as a chronic dry cough. The main differential diagnoses for miliary nodules can be remembered using the mnemonic TEMPeSt: Tuberculosis, Eosinophilic granuloma, Metastases, Pneumoconiosis, Sarcoidosis. Miliary Tuberculosis Radiology and Diagnosis Miliary TB is characterized by the presence of numerous small nodular lesions that resemble millet seeds on chest x-ray. 2. 6. Miliary tuberculosis (TB) results from a massive lymphohematogenous dissemination of Mycobacterium tuberculosis bacilli and is characterized by tiny tubercles evident on gross pathology resembling millet seeds in size and appearance. Only in 5% of patients, usually those with impaired immunity, go on to have progressive primary tuberculosis. 2010;85 (2): 108. Mayo Clin. Only patients who had a good quality posteroanterior or anteroposterior chest radiograph as determined by an independent expert chest radiologist were included in the study. High resolution CT findings in miliary lung disease. Tuberculosis radiology. Widespread hematogenous dissemination of Mycobacterium Tuberculosis So named because the nodules are the size of millet seeds (1-5mm with a mean of 2 mm) Miliary TB represents only 1-3% of all cases of TB Older men, African Americans and pregnant women are susceptible Roche CJ, O'keeffe DP, Lee WK et-al. Papillary thyroid carcinoma with miliary metastases. Results: In all cases, HRCT showed diffusely disseminated nodules up to 3 mm. 1. This patient went on to receive appropriate systemic antibiotics. Acta Radiol. Pulmonary alveolar proteinosis in children. In this case splenic and hepatic involvement is evident. Another imaging study like computed tomography imaging of the lungs and abdomen can also be supportive in diagnosing miliary tuberculosis. 3. Authors J Andreu 1 , S Mauleón, E Pallisa, J Majó, M Martinez-Rodriguez, J Cáceres. Similar findings to plain radiograph but may more elaborately show extent and distribution. Check for errors and try again. Jolobe OM. Miliary tuberculosis has a mild clinical and a poor prognosis. Its appearance is often indistinguishable from that of bacterial pneumonia; however, it can be differentiated from bacterial pneumonia on the bas… 2003;31 (5): 189-97. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Discussion: Miliary Tuberculosis (TB) was initially suspected, despite the direct microscopic examination from bronchoalveolar lavage was negative for acid-fast bacilli because imaging showed miliary opacities, and transbronchial lung biopsy revealed the presence of typical caseating granulomas. Abnormalities on chest radiographs may be suggestive of, but are never diagnostic of TB, but can be used to rule out pulmonary TB. 54 (19): 2483-6. Imaging.—At CT, micronodular or miliary TB affecting the liver and spleen appears as multiple small hypoattenuating nodules spread throughout the parenchyma. 21 public playlist includes this case. 5 (4): e00238. McGuinness G, Naidich DP, Jagirdar J et-al. Althoughthe term “miliary” is used widely for the description of diffuse pulmonary micronodules, it should be confined to randomly distributed micronodules. 22 (6): 1369-84. The records from the TB registry for the Province of British Columbia, Canada, were reviewed for cases of miliary TB from November 1982 to November 1992. 2010;363 (11): 1059. The principal means of testing for active tuberculosis is sputum analysis, including smear, culture, and nucleic acid amplification testing. High-resolution computed tomography can help to narrow the differential diagnosis of miliary lung diseases. At radiology, primary tuberculosis manifests as four main entities: parenchymal disease, lymphadenopathy, miliary disease, and pleural effusion. Abdominal Ultrasound scan will show hepatomegaly, splenomegaly and … These lesions are about 1 to 2 mm in size. Radiographics. Furqan M, Butler J. Miliary pattern on chest radiography: TB or not TB?. Miliary TB also seen after intravesical BCG immunotherapy for transitional cell carcinoma of bladder Axial HRCT in this patient with miliary tuberculosis shows innumerable miliary nodules, which have a random pattern of distribution. Nevertheless, because of similarity in appearances on different conventional magnetic imaging (MRI) sequences, (MRI) cannot always provide enough information for differentiation of these lesions. Since this is a life threatening disease we should start empiric treatment. April 2020. 2. Eur Spine J. Miliary tuberculosis. Twenty-six percent of cases were infants under 12 months of age. Additionally, some miliary opacities are very dense, narrowing the differential - see multiple small hyperdense pulmonary nodules. Arch. Miliary tuberculosis is a form of Disseminated TB or Extrapulmonary TB that is caused by sudden diffuse dissemination of tubercle bacilli through the bloodstream (hematogenous spread … Read More .. Conditions to consider in the differential diagnosis of Pott disease include the following: ... Shetty AP, Rajasekaran S. Diagnostic accuracy of whole spine magnetic resonance imaging in spinal tuberculosis validated through tissue studies. Miliary tuberculosis may affect one organ or several organs or occur throughout the body. Zhang X, Ji J, Liu B. The miliary pattern is common to various diseases, and no single imaging feature is specifically diagnostic. Tuberculosis (TB) is a serious infection that usually affects only your lungs, which is why it’s often called pulmonary tuberculosis. Mu XD, Wang GF. We have used a grouping based on serial roentgenograms and not on the clinical course, which usually, but not invariably, coincides with it. Selections from the buffet of food signs in radiology. 1977;28 (3): 175-81. 2019 Jun 14. . Nov 27, 2017 - What is Miliary Tuberculosis? Typically, parenchymal disease manifests as dense, homogeneous parenchymal consolidation in any lobe; however, predominance in the lower and middle lobes is suggestive of the disease, especially in adults. Antitubercular treatment with the classic four-drug regimen was initiated. 4. Mccook TA, Kirks DR, Merten DF et-al. Purpose: To analyze high resolution CT (HRCT) features of a miliary pattern in different diseases. 4. Miliary tuberculosis (TB) is the widespread dissemination of Mycobacterium tuberculosis (see the image below) via hematogenous spread. Differential diagnoses include fungal infection, lymphoma, and metastases (34,35). 28 (7): e32. Unable to process the form. Tuberculosis creates cavities visible in x-rays like this one in the patient's right upper lobe. There are multiple areas of consolidation. Now continue with the HRCT. [ 3 ] Tap on/off image to show/hide findings. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Miliary tuberculosis represents uncontrolled tuberculous infection and carries a relatively poor prognosis. Tuberculosis (TB) (see the image below), a multisystemic disease with myriad presentations and manifestations, is the most common cause of infectious disease–related mortality worldwide. Reed MH, Pagtakhan RD, Zylak CJ et-al. N. Engl. Collins J, Stern EJ. Computed tomography in miliary tuberculosis. 9. (2017) Respirology case reports. Taki M, Ikegami N, Konishi C, Nakao S, Funazou T, Ariyasu R, Yoshida M, Nakagawa K, Morita K, Hee Hwang M, Yoshimura C, Wakayama T, Nishizaka Y. J. Med. Sep-Oct 2002;31(5):189-97. Although most easily seen in the lungs, miliary TB is a systemic illness with solid organs also affected. Miliary tuberculosis refers to hematogenously disseminated disease that is more commonly seen in immunocompromised patients, who present with miliary lung nodules and multiorgan involvement. Dis. Radiologic features of miliary tuberculosis in children and adults. Differential Diagnosis of Miliary Pattern of Micronodules Miliary nodules are a subset of randomly distributednodules. The primary infection is usually asymptomatic (the majority of cases), although a small number go on to have symptomatic hematological dissemination which may result in miliary tuberculosis. Language; Watch; Edit; Radiology (X-rays) is used in the diagnosis of tuberculosis. Voloudaki AE, Tritou IN, Magkanas EG et-al. It represents haematogenous dissemination of uncontrolled tuberculous infection and carries a relatively poor prognosis. J Comput Assist Tomogr. Miliary tuberculosis is an uncommon pulmonary manifestation of tuberculosis. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":20955,"mcqUrl":"https://radiopaedia.org/articles/miliary-tuberculosis/questions/1092?lang=us"}. 7. In this article, we describe the imaging findings of male genital tuberculosis and the differential diagnosis. 2013 Oct. … Chest radiology, the essentials. Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term " miliary" tuberculosis. Only in 5% of patients, usually those with impaired immunity, go on to have progressive primary tuberculosis. It most often affects the lungs, liver, and bone marrow but may affect any organ, including the tissues that cover the brain and spinal cord (meninges) and the two-layered membrane around the heart (pericardium). corkscrew sign (diffuse esophageal spasm), bunch of grapes sign (botryoid rhabdomyosarcoma), bunch of grapes sign (intracranial tuberculoma), bunch of grapes sign (multicystic dysplastic kidney), bunch of grapes sign (intraosseous hemangiomas), Differential of miliary pulmonary opacities. Patients with post-primary pulmonary tuberculosis are often asymptomatic or have only minor symptoms, such as a chronic dry cough. The term miliary is derived from the millet seed, a term used to describe a group of small-seeded species of cereal crops or grains, widely grown around the world for food and fodder 5. The differential diagnosis now includes tumor (bronchoalveolar carcinoma or lymphoma), eosinophilic pneumonia, organizing pneumonia, Wegener's disease or an uncommon presentation of sarcoidosis. Pictorial review of tuberous sclerosis in various organs. Jayaschandran V, Gjorgova-Gjeorgjievski S, Siddique H. An uncommon cause of miliary pattern of pulmonary nodules-diffuse pulmonary meningotheliomatosis. Material and methods: Eight HRCT studies with a miliary lung pattern were retrospectively reviewed with the diagnoses tuberculosis (n=3), Candida albicans (n=1), sarcoidosis (n=3), and metastatic adenocarcinoma (n=1). In some cases, hepatosplenomegaly is the only imaging finding. 5. ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. 1981;137 (5): 1023-7. Miliary TB. Child. Pulmonary Sarcoidosis Presenting with Miliary Opacities. 1999;40 (4): 451-6. J Can Assoc Radiol. Internal medicine (Tokyo, Japan). If treatment is successful no residual abnormality remains. Andreu J, Mauleón S, Pallisa E et-al. Management of spinal tuberculosis: a systematic review and meta-analysis. Images in clinical medicine. The most common etiology is infectious, such as miliary tuberculosis (TB) and histoplasmosis, but miliary shadows can be the presentation of sarcoidosis, pneumoconiosis, and secondary metastasis to the lungs from primary cancers of the thyroid, kidney, and trophoblasts as well as sarcomas. Proc. Miliary shadows on chest imaging have wide differential diagnoses. Umeoka S, Koyama T, Miki Y et-al. In addition to a metastatic brain tumor, radiological differential diagnosis of these lesions includes miliary brain tuberculosis, neurocysticercosis or toxoplasmosis. The causes can be broadly subgrouped dependent on whether or not the patient is febrile. Hover on/off image to show/hide findings. It represents haematogenous dissemination of uncontrolled tuberculous infection and carries a relatively poor prognosis. Curr Probl Diagn Radiol. Axial HRCT in the same patient more inferiorly shows miliary nodules uniformly distributed throughout the lung. Figure 2: gross pathology miliary tuberculosis, Case 6: papillary thyroid cancer metastases, Case 8: papillary thyroid cancer metastases, multiple small hyperdense pulmonary nodules, multifocal micronodular pneumocyte hyperplasia (MMPH), hockey stick sign (Creutzfeldt-Jakob disease), stepladder sign (intracapsular breast implant rupture), stepladder sign (small bowel obstruction), eccentric target sign (cerebral toxoplasmosis), trident sign (persistent primitive trigeminal artery), ginkgo leaf sign (subcutaneous emphysema), butterfly shape of the grey matter of the spinal cord, snake-eye appearance (cervical spinal cord), caput medusae sign (developmental venous anomaly), ice cream cone sign (middle ear ossicles), ice cream cone sign (vestibular schwannoma), in total anomalous pulmonary venous return, immunocompromised or elderly patients may be afebrile, small acinar opacities can mimic a miliary pattern. 1. It is seen both in primary and post-primary tuberculosis and may be associated with tuberculous infection in numerous other tissues and organs. Classic miliary TB is defined as milletlike (mean, 2 mm; range, 1-5 mm) seeding of TB bacilli in the lung, as evidenced on chest radiography. The most common entities with this pattern are miliary tuberculosis, pneumoconiosis, sarcoidosis, metastases, and hypersen … Miliary lung disease revisited Curr Probl Diagn Radiol. Miliary tuberculosis occurs most often in the following: Children under 4 years old. High-resolution ultrasonography (HRUS) is the best modality for assessing the epididymis, testis, scrotum and vas deferens, whereas MRI is optimal for evaluating the prostate, seminal vesicles and ejaculatory ducts. J Int Med Res. It is useful to divide these patients into those who are febrile and those who are not. 1992;16 (3): 384-90. Although TB rates are decreasing in the United States, the disease is becoming more common in many parts of the world. Classification of miliary diseases into acute, subacute, and chronic categories offers certain advantages in differential diagnosis. AJR Am J Roentgenol. Unable to process the form. Miliary tuberculosis is an uncommon pulmonary manifestation of tuberculosis. Miliary lung disease revisited. The primary infection is usually asymptomatic (the majority of cases), although a small number go on to have symptomatic haematological dissemination which may result in miliary tuberculosis. Miliary deposits appear as 1-3 mm diameter nodules, which are uniform in size and uniformly distributed. HRCT in miliary lung disease. 8. In symptomatic patients, constitutional symptoms are prominent with fever, malais… Miliary TB is due to disseminated spread of mycobacterial infection; It can occur either at the time of primary infection or on disease reactivation – prognosis is poor; Very fine nodules are typically seen scattered throughout the lungs Lippincott Williams & Wilkins. {"url":"/signup-modal-props.json?lang=us\u0026email="}, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":1679,"mcqUrl":"https://radiopaedia.org/articles/miliary-opacities-lungs/questions/1092?lang=us"}. Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). 2006;91 (4): 373-4. (2007) ISBN:0781763142. The term miliary opacities refers to innumerable, small 1-4 mm pulmonary nodules scattered throughout the lungs.It is useful to divide these patients into those who are febrile and those who are not.. Additionally, some miliary opacities are very dense, narrowing the differential - see multiple small hyperdense pulmonary nodules. It is seen both in primary and post-primary tuberculosis and may be associated with tuberculous infection in numerous other tissues and organs. In symptomatic patients, constitutional symptoms are prominent with fever, malais… Miliary Tuberculosis (TB) Symptoms, Causes, Radiology, Diagnosis & Differential Diagnosis - Jotscroll. Article from jotscroll.com. The most frequent clinic presentations are: fever, fatigue, anorexia, weight loss and hepatomegaly[1]. In 1700, John Jacob Manget 1) described a form of disseminated tuberculosis (TB) and likened the tiny tubercles evident on gross pathological examination to that … When a immune compromised patient presents this symptomatology we must include this entity in the differential diagnosis. 3. In the course of 3 1/2 years, 27 children with miliary tuberculosis were seen at the Hospital Infantil Lorencita Villegas de Santos in Bogotá, Columbia. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Chest X-ray. Check for errors and try again. Miliary TB . In selected cases the distribution of the nodules, associated radiologic findings and clinical features point to a definite etiologic diagnosis. The term miliary opacities refers to innumerable, small 1-4 mm pulmonary nodules scattered throughout the lungs. Rather than reciting a list of differentials in an exam, a better approach is to show the examiner how you would narrow the differential.
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