Chest Imaging

Miliary tuberculosis

form of disease seen in both primary and postprimary infections with Mycobacterium tuberculosis. Patients are generally very ill with respiratory failure, fever and malaise at the time of diagnosis. The chest film demonstrates small (12 mm in diameter) nodular opacities throughout both lungs that are too numerous to count (Fig.1). Untreated disease results in steady enlargement of these nodules until death of the patient ensues. Lymphadenopathy and pleural fluid or other evidence of primary or postprimary tuberculosis may not be present on the chest film. Diagnosis may require transbronchial biopsy to identify acid-fast bacilli. When treated the miliary pattern gradually disappears leaving a normal chest film within several weeks to months.

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Fig.1

One to two mm in diameter nodules are seen throughout both lungs on this PA chest film. This pattern is highly suggestive of miliary tuberculosis. As the disease worsens the nodules become larger and may attain a size of 5 or 6 mm in diameter. At this stage of the disease, however, patients usually succumb to tuberculosis. If treated successfully the nodules disappear over a period of weeks to months.
Miliary tuberculosis, Fig.1