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Weekly Chest CasesArchive of Old Cases

Case No : 1061 Date 2018-02-26

  • Courtesy of Chan Ho Park, MD, Young Tong Kim, MD, Sung Shick Jou, MD. / Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine
  • Age/Sex 74 / F
  • Chief ComplaintFever with night sweating, underlying Crohn's ds with infliximab started 2 months ago
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Miliary tuberculosis
Radiologic Findings
Fig 1. Chest PA shows numerous tiny nodules in both lung fields.
Fig 2-4 Chest CT scan shows numerous military nodules in both lungs.
Fig 5 Mediastinal setting chest CT scan shows enlarged right paratracheal lymphadenopathy
Brief Review
Miliary tuberculosis (TB) refers to clinical disease resulting from the hematogenous dissemination of Mycobacterium tuberculosis. Miliary TB can arise as a result of progressive primary infection or via reactivation of a latent focus with subsequent spread. The term miliary TB was originally a pathologic and then a radiographic description; it is now used more broadly (and incorrectly) by some to denote all forms of progressive, widely disseminated TB, whether or not disease presents with the classic radiographic or pathologic nodular appearance characteristic of hematogenous spread. Use of biologic agents such as tumor necrosis factor (TNF)-alpha inhibitors has been associated with a disproportionate increase in cases of extrapulmonary and miliary tuberculosis among individuals treated with these agents.
References
1. Jeong YJ, Lee KS. Pulmonary tuberculosis: up-to-date imaging and management. AJR 2008; 191: 834-844.
2. Keane J, Gershon S, Wise RP et al. Tuberculosis associated with infliximab, a tumor necrosis factor alpha-neutralizing agent. N Eng J Med 2001; 345: 1098.
Keywords
Lung, Lymph node, Infection, Pulmonary tuberculosis,

No. of Applicants : 112

▶ Correct Answer : 82/112,  73.2%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Chonbuk National University Medical School , Korea (South) HYEJIN YANG
  • - Chonbuk National University Hospital , Korea (South) MINGI SHIN
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHEELLE , France JEAN LUC BIGOT
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - Chonbuk National University Hospital , Korea (South) SANGHEON KIM
  • - Chonbuk National University Hospital , Korea (South) EUN HA JUNG
  • - , Korea (South) SUYON CHANG
  • - Soonchunhyang University College of Medicine , Korea (South) GOUN CHOI
  • - Chonnam National University Hospital , Korea (South) MOON GYEONG IL
  • - Other , Korea (South) HEE SEOK CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - , Korea (South) SUNGHEE SHIN
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Freelance resident in Reunion Island , Reunion Fabien HO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - , India THE GREAT WARRIOR
  • - Qatif Central Hospital , Saudi Arabia Hani Makky Al Salam
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Jikei University school of medicine , Japan SHIGEKI MISUMI
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Intermed Hospital , Mongolia KHULAN KHURELSUKH
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Kurashiki Central Hospital , Japan TORU KONISHI
  • - NTUH , Taiwan KUEI-PIN CHUNG
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - , Korea (South) EUNJIN LEE
  • - National Taiwan University Hospital Hsin-Chu Branch , Taiwan LI-TA KENG
  • - Other , Korea (South) JIN YOUNG KIM
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - , France, Metropolitan MOLLION MELANIE MOLLION
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Maimonides Medical Center , United States NAOMI TWERSKY
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Sarawak General Hospital , Malaysia POHSEN TAY
  • - Wuhan Union Hospital , China QIGUANG CHENG
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Escola Paulista de Medicina , Brazil RENATO MASSON DE ALMEIDA PRADO
  • - District TB centre, kasaragod,India , India rikhy krishnan
  • - Korea University Guro Hospital , Korea (South) KYU-CHONG LEE
  • - MBAL BURGAS , Bulgaria VLADISLAV BOYANOV RUSINOV
  • - , India SAHITHI REDDY IRALA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Gachon University Gil Hospital , Korea (South) KIHYUN LEE
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
  • - University of Utah , United States AKIHIKO SAKATA
  • - Hallym University Dongtan Medical Center , Korea (South) KIM AYEON
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - , China YIN LIU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 14/112,  12.5%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - dayanand , India REENA GUPTA
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Kyeongpook National University Hospital , Korea (South) CHUNGEUN LIM
  • - MD , India DEEPANDER SINGH RATHORE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Seoul National University Hospital , Korea (South) JI HEE KANG
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - , Korea (South) JANG SEONG WON
  • - SRMC , India PRABHU RADHAN RADHAKRISHNAN
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Semi-Correct Answer : 3/112,  2.7%
  • - HHS , Canada S LEE
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Multimagem Diagn泥˜sticos , Brazil PEDRO PAULO TEIXEIRA E SILVA TORRES
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