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{{Miliary tuberculosis}}
'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
{{Infobox_Disease
{{Infobox_Disease
  | Name          = {{PAGENAME}}
  | Name          = {{PAGENAME}}
  | Image          = Miliary-TB-003.jpg
  | Image          = Miliary-TB-003.jpg
  | Caption        = Miliary tuberculosis. <br> [http://www.radswiki.net Image courtesy of RadsWiki]
  | Caption        = Miliary tuberculosis. <br> [http://www.radswiki.net Image courtesy of RadsWiki]
| DiseasesDB    =
| ICD10          = {{ICD10|A|19||a|15}}
| ICD9          = {{ICD9|018}}
| ICDO          =
| OMIM          =
| MedlinePlus    =
| MeshID        = D014391
}}
}}
{{Miliary tuberculosis}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
==Overview==
'''Miliary tuberculosis''' (or '''disseminated TB''') 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). Its name comes from a distinctive pattern seen on a chest [[X-ray]] of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds, thus the term "miliary" tuberculosis.  Miliary TB may infect any number of organs including the lungs, liver, and spleen.  It is a complication of 1-3% of all TB cases.<ref name="Lessnau">Lessnau, Klaus-Dieter, "Miliary Tuberculosis", http://www.emedicine.com/med/topic1476.htm, October 3, 2006.</ref>
==Differential Diagnosis of Miliary Pattern on chest X-ray==
*[[Miliary tuberculosis]]
*[[Varicella|Varicella pneumonia]]
*[[hypersensitivity pneumonitis|Acute hypersensitivity pneumonitis]]
*[[Fungal pneumonia]]
*[[Thyroid cancer|Thyroid cancer metastases]]
*[[Renal cell carcinoma|Renal cell carcinoma metastases]]


==Etiology==
{{SK}} Tuberculosis - disseminated; disseminated tuberculosis; disseminated TB; extrapulmonary tuberculosis
==[[Miliary tuberculosis overview|Overview]]==
==[[Miliary tuberculosis historical perspective|Historical Perspective]]==


Miliary tuberculosis is a form of tuberculous infection in the lung that is the result of erosion of the infection into a pulmonary vein<ref name=Robbins> Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson; & Mitchell, Richard N. (2007). ''Robbins Basic Pathology'' (8th ed.). Saunders Elsevier. pp. 516-522 ISBN 978-1-4160-2973-1</ref>.  Once the bacteria reach the left side of the heart and enter the systemic circulation, the result may be to seed organs such as the liver and spleen with said infection.  Alternately the bacteria may enter the lymph node(s), drain into a systemic vein and eventually reach the right side of the heart<ref name=Robbins/>.  From the right side of the heart, the bacteria may seed - or re-seed as the case may be - the lungs, causing the eponymous "miliary" appearance.
==[[Miliary tuberculosis pathophysiology|Pathophysiology]]==


==Signs and Symptoms==
==[[Miliary tuberculosis causes|Causes]]==


A patient with miliary tuberculosis will tend to present with non-specific signs such as low grade [[fever]], [[cough]], and generalized [[lymphadenopathy]]. Miliary tuberculosis can also present with [[hepatomegaly]] (40% of cases), [[splenomegaly]] (15%), [[pancreatitis]] (<5%), and multiorgan dysfunction with [[adrenal insufficiency]].<ref name="Lessnau"/>
==[[Miliary tuberculosis differential diagnosis|Differentiating Miliary tuberculosis from other Diseases]]==


==Diagnostic Findings==
==[[Miliary tuberculosis epidemiology and demographics|Epidemiology and Demographics]]==


===Video showing chest xray in miliary tuberculosis===
==[[Miliary tuberculosis risk factors|Risk Factors]]==
{{#ev:youtube|xmYE1BlMjno}}


===Common findings of miliary tuberculosis on chest x ray===
==[[Miliary tuberculosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
* Fine, pin point approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
* Commonly found throughout both the lungs.


[http://www.radswiki.net Images courtesy of RadsWiki]
==Diagnosis==


[[Image:Miliary-TB-002.jpg|left|thumb|350px|Miliary tuberculosis]]
[[Miliary tuberculosis history and symptoms|History and Symptoms]] | [[Miliary tuberculosis physical examination|Physical Examination]] | [[Miliary tuberculosis laboratory findings|Laboratory Findings]] | [[Miliary tuberculosis chest x ray|Chest X Ray]] | [[Miliary tuberculosis CT|CT]] | [[Miliary tuberculosis MRI|MRI]] | [[Miliary tuberculosis other imaging findings|Other Imaging Findings]] | [[Miliary tuberculosis other diagnostic studies|Other Diagnostic Studies]]
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[[Image:Miliary-TB-003.jpg|left|thumb|350px|Miliary tuberculosis]]
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[[Image:Miliary-TB-004.jpg|left|thumb|350px|Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 001.jpg|left|thumb|350px|FLAIR: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 002.jpg|left|thumb|350px|FLAIR: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 003.jpg|left|thumb|350px|T1 with GAD: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 004.jpg|left|thumb|350px|T1 with GAD: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 005.jpg|left|thumb|350px|T1 with GAD: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 006.jpg|left|thumb|350px|T1 with GAD: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 007.jpg|left|thumb|350px|T1 with GAD: Miliary tuberculosis]]
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[[Image:Miliary tuberculosis 008.jpg|left|thumb|350px|T1 with GAD: Miliary tuberculosis]]
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==Treatment==
==Treatment==
:''See:'' [[Tuberculosis treatment]]
Miliary TB is a serious condition; untreated miliary TB is almost always fatal.  About 25% of patients with miliary TB also have [[tuberculous meningitis]].  The standard treatment recommended by the [[World Health Organisation|WHO]] is with [[isoniazid]] and [[rifampicin]] for six months, as well as [[ethambutol]] and [[pyrazinamide]] for the first two months.  If there is evidence of [[meningitis]], then treatment is extended to twelve months.  The US guidelines recommend nine months' treatment.


== References ==
[[Miliary tuberculosis medical therapy|Medical Therapy]] | [[Miliary tuberculosis primary prevention|Primary Prevention]] | [[Miliary tuberculosis secondary prevention|Secondary Prevention]] | [[Miliary tuberculosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Miliary tuberculosis future or investigational therapies|Future or Investigational Therapies]]
<references/>


[[da:Miliærtuberkulose]]
==Case Studies==
[[Miliary tuberculosis case study one|Case #1]]


[[Category:Tuberculosis]]
==Related Chapters==
[[Category:Bacterial diseases]]
*[[Tuberculosis]]
[[Category:Infectious disease]]


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Latest revision as of 18:05, 18 September 2017

For patient information click here

Miliary tuberculosis
Miliary tuberculosis.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Synonyms and keywords: Tuberculosis - disseminated; disseminated tuberculosis; disseminated TB; extrapulmonary tuberculosis

Overview

Historical Perspective

Pathophysiology

Causes

Differentiating Miliary tuberculosis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

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