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Weekly Chest CasesArchive of Old Cases

Case No : 600 Date 2009-04-27

  • Courtesy of Bae Young Lee / Department of Radiology, St. Paul hospital, Medical College, Catholic University of Korea.
  • Age/Sex 70 / F
  • Chief ComplaintC/C: fever for 1day & poor oral intake for 1month
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Miliary tuberculosis with multiple lymphadenopathy
Radiologic Findings
Chest radiographs show diffuse ground glass opacities and numerous tiny nodules of both lung fields, and reveals wedge shaped increased opacity of left upper lung field, suggesting old tuberculosis lesion.
Chest CT revealed diffuse ground glass opacities (GGO) and military nodules of both lung fields and scars of left upper lobe on lung setting, and fine intralobular networks are also suspected (figure 1, 2). Multiple markedly enlarged lymph nodes with necrosis are seen in right supraclavicular area and axilla without necrosis on contrast enhanced axial and coronal scan (Figure 3, 4).
Biopsy was performed in lymph node of right axilla, and tuberculosis was confirmed.
Brief Review
Miliar tuberculosis is widespread hematogenous dissemination of tuberculosis. It occurs in primary and reactivation tuberculosis, more frequently in reactivation tuberculosis. This patient has also old tuberculosis lesion in left upper lobe. Typical radiologic findings are randomly distributed numerous 1-3mm size nodule in both lungs. Thickening of interlobular septa and fine intralobular networks are frequently seen. Diffuse or localized GGO are also sometimes seen, and GGO may be a sign of ARDS.
Please refer to
Case 157,
References
1. Jeong YJ, Lee KS. Pulmoanry tuberculosis: up-to-date imaging and management. AJR 2008;191;834-844.
Keywords
lung, Multiple organ, Infection, Bacterial infection, Tuberculosis,

No. of Applicants : 90

▶ Correct Answer : 33/90,  36.7%
  • - POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV
  • - WARABI CITY HOSPITAL , Japan YASUO OKUBO
  • - Seoul National University Hospital , Korea (South) Sang Min Lee
  • - KONARK DIAGNOSTIC CENTRE , India AHAMAD MUKARRAB
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - CHU caen , France nicolas gautier
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
  • - mediciti hospitals , India paramjyothi gongati
  • - National Taiwan University Hospital, YL branch , Taiwan Chin-Chung Shu
  • - Gimpo Woori Hospital , Korea (South) Son Youl Lee
  • - Saga University , Japan Ryoko Egashira
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Apollo Gleneagles hosp kolkata , India salim parvez
  • - CHUV , Switzerland Andrea Ojanguren
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - CH Sud R�union , Reunion jean-baptiste Noel
  • - john h stroger hsp , United States dheeraj reddy gopireddy
  • - Medical IT Consulting , Japan Kazumasa Nishimura
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - CHU GRENOBLE FRANCE , France anne-line MORONI
  • - NASA SCANS , India RAKESH BHATIA
  • - Trakya Univercity School of Medicine , Turkey Armagan Sarac
  • - IRSA , France jean BIGOT
  • - chp st martin , France Mariotte benoit
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
  • - PITTWATER RADIOLOGY , Australia Saurabh Khandelwal
  • - PITTWATER RADIOLOGY , Australia Julie Arora
  • - Changhua Christian Hospital , Taiwan Chia-Fu Tsai
▶ Correct Answer as Differential Diagnosis : 27/90,  30.0%
  • - Shiga University of Medical Science , Japan Norihisa Nitta
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - McGill University Health Center , Canada Faiza Al Kindi
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - EKH-Berlin , Germany Michael Weber
  • - NTUH , Taiwan Kuei-pin Chung
  • - kims,narkatpally , India k bhaskar
  • - hospital Sao Paulo , Brazil israel missrie
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - CHRU lille , France manuel toledano
  • - CHRU Lille , France Benjamin Damarey
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Seoul Nationial University Bundang Hospital , Korea (South) Kyoung Jin Oh
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - Kyungpook National Univ. Hospital , Korea (South) Sang-yub Lee
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - The Armed Forces Daegu Hospital , Korea (South) Hyungwoo Oh
  • - KKUH , Saudi Arabia NABIL GHALEB
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Toyama University Hospital, Laboratory of Pathology , Japan TANAKA TOMONORI
  • - CHU Grenoble , France Fabrice Bing
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - NMC hospital Dubai , United Arab Emirates vickrant malhotra
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