Miliary tuberculosis
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Miliary tuberculosis Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Miliary tuberculosis On the Web |
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American Roentgen Ray Society Images of Miliary tuberculosis |
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| 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]
Differential Diagnosis of Miliary Pattern on chest X-ray
- Miliary tuberculosis
- Varicella pneumonia
- Acute hypersensitivity pneumonitis
- Fungal pneumonia
- Thyroid cancer metastases
- Renal cell carcinoma metastases
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[1]. 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[1]. 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
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.[2]
Diagnostic Findings
Video showing chest xray in miliary tuberculosis
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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.
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.