His imaging findings suggested a miliary pattern
. This combined with his clinical symptoms and environmental exposure history was concerning for an invasive fungal infection or tuberculosis (TB).
Another rarely reported features are solitary pulmonary nodule, interstitial lung disease, cystic lesions, cavitary lung nodules, and miliary pattern
[5, 8, 11].
Disseminated tuberculosis with and without a miliary pattern
on chest radiograph: a clinical-pathologic-radiologic correlation.
These can be solitary, multifocal or in a miliary pattern
. The lesions are usually larger than in immunocompetent individuals and there may be no pre-existing retinal scar.
Chest imaging showed a diffuse infiltrate in a miliary pattern
. Noncontrast computed tomography scan of the head was normal.
HRCT shows a miliary pattern
of innumerable tiny nodular densities in both lungs.
The predominance of miliary nodules in relation to cephalocaudal axis, their margin and size are not helpful features to the differential diagnosis of diseases presenting with a miliary pattern
and pneumothorax are rare radiological features in pulmonary tuberculosis.
Radiographically, blastomycosis can appear as a consolidation, a miliary pattern
,[7,13,22] or even as a lung mass.[23,24] Often the patient is treated for presumed bacterial pneumonia,[5-8,11,16] and the presence of the miliary pattern
can lead to a misdiagnosis of tuberculosis.[7,13,15,22] Our patient was treated for both during her 6-month illness.
Conventional chest radiography (Figure 1) found a diffuse miliary pattern
, which was also identified on subsequent computed tomography of the chest.