X-Ray: Miliary Tuberculosis

1. -Dr. Prof. TITO’s
Unit
Dr. Pandichelvan R .

6. -Most commonly manifest as post primary TB
rather than Primary TB in older patients
-Purely Nodular Pattern in febrile patient with
acute presentation suggestive of
hematogenous infection, particularly miliary
TB.
-Radiological evidence usually takes several
weeks to appear.
MILIARY TUBERCULOSIS

7. Imaging Findings
Discrete Distinctive Pin-point opacities WHY NODULARITY?
Nodule size 1 – 2 mm in diameter -SPHERICAL LESION IN
Miliary ( millet seed ) Pattern INTERSTITIUM
B/L even distribution -WELL CIRCUMSCRIBED
Basal Predominance HOMOGENOUS PATTERN
Rare or non-existent calcifications
Upto 30 % no radiological signs
Thickening of intralobar fissure / interlobular septa
Nodular irregularity of vessels
HRCT – more sensitive

8. Differential diagnosis
PNEUMOCONIOSIS
- Coal Workers Pneumoconiosis
- Silicosis
- Siderosis
- Stannosis
SARCOIDOSIS
METASTATIC LUNG DISEASES
NON TB INFECTIONS
- Histoplasmosis
- Blastomycosis
- Cryptococcosis
- Nocardiosis
- Coccidiodomycosis
BRONCHIOLITIS OBLITERANS

9. SILICOSIS :
Multiple well circumscribed nodules
Uniform density
Upper lobe predominance
Mainly posterior lobe
Nodular Calcification seen in 10 – 20 % cases
Hilar lymphadenopathy
Egg Shell Calcification
:

10. COAL WORKERS PNEUMOCONIOSIS:
Simple Pneumoconiosis
small round nodule 1 – 5mm
granular densities
calcifications begin as central dot
Complicated Pneumoconiosis
large opacities > 1cm
upper lung zones
start peripherally

11. Metastatic Lung Disease
75% -multiple pulmonary nodules
B/L with basal predominance
peripheral lesions ( subpleural )
cavitatory lesions
squamous carcinomas
sarcomas
calcification rare ,except in
osteogenic sarcoma
chondrosarcoma
mucinous adenocarcinoma

12. SARCOIDOSIS
B/L symmetrical diffuse pulmonary disease
B/L Hilar lymphadenopathy
Upper zone mainly
Imaging Patterns:
m/c nodular
reticulo-nodular
reticular pattern
(rare) air space consolidaton
ground glass opacification