High-resolution CT appearance of miliary tuberculosis

The purpose of this study was to define the range of abnormalities and to assess the contribution of high-resolution CT (HRCT) in the evaluation of miliary tuberculosis involving the lung parenchyma.

The authors retrospectively reviewed HRCT scans of 11 patients with microbiologically or clinically proved miliary tuberculosis.

In 10 patients, the most characteristic HRCT finding of miliary tuberculosis was the presence of small nodules uniformly distributed throughout both lungs. The profusion of nodules was numerous in all 10 patients. High-resolution CT scans showed both sharply and poorly defined, small nodules varying in sizes from 1 to 2 mm (n = 6), 1 to 3 mm (n = 2), and 1 to 4 mm (n = 2) in diameter. These nodules had a diffuse random distribution in the secondary lobule in all 10 patients. In 1 of the 10 patients with small nodules on HRCT, chest radiography had shown no evidence of miliary nodules in the lung. In addition to nodules, HRCT showed diffuse or localized reticular opacities superimposed on nodules in five patients, especially in the lower lung zones. In 1 of all 11 patients, ground-glass attenuation was the predominant abnormality seen on HRCT.

We believe that in the appropriate clinical situation, miliary tuberculosis may be suggested on HRCT. Moreover, in cases with no evidence of miliary nodules on the chest radiograph, HRCT scan may depict miliary nodules in the lung parenchyma.