Miliary tuberculosis: Difference between revisions

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{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
==Etiology==
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.
==Signs and Symptoms==
==Signs and Symptoms==



Revision as of 13:24, 12 October 2012

Miliary tuberculosis Microchapters

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Overview

Historical Perspective

Pathophysiology

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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

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Miliary tuberculosis
Miliary tuberculosis.
Image courtesy of RadsWiki
ICD-10 A19
ICD-9 018
MeSH D014391

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

Signs and Symptoms

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.[1]

Diagnostic Findings

Video showing chest xray in miliary tuberculosis

{{#ev:youtube|xmYE1BlMjno}}

Common findings of miliary tuberculosis on chest x ray

  • Fine, pin point approximately 1-2mm in size, discrete, uniform distribution, soft mottlings.
  • Commonly found throughout both the lungs.

Images courtesy of RadsWiki

Miliary tuberculosis


Miliary tuberculosis


Miliary tuberculosis


FLAIR: Miliary tuberculosis


FLAIR: Miliary tuberculosis


T1 with GAD: Miliary tuberculosis


T1 with GAD: Miliary tuberculosis


T1 with GAD: Miliary tuberculosis


T1 with GAD: Miliary tuberculosis


T1 with GAD: Miliary tuberculosis


T1 with GAD: Miliary tuberculosis


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 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

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