macrophages, neutrophils, or amorphous material [59]. Histopathologically, diffuse interstitial inflammatory infiltrates and innumerable tiny granulomas scattered throughout the pulmonary interstitium account for diffuse intralobular lines and interlobular septal thickening [52].

Patient Prognosis

Miliary TB is uniformly fatal if not treated. Anti-TB treatment for at least 9–12 months is recommended. Adjunctive treatment with corticosteroids may be useful for those with refractory hypoxemia. The mortality related to miliary TB is about 25–39 % in adults patients [58]. Delay in the diagnosis or commencement of treatment appears to be an important cause of mortality.

Miliary Metastasis

Pathology and Pathogenesis

The nodules, usually dense and well defined, tend to appear evenly distributed (Fig. 18.15). Individual nodules may have feeding vessels consistent with their hematogenous origin [61].

Symptoms and Signs

In patients with miliary metastasis, clinical manifestations are nonspecific. Cough and dyspnea are the most common respiratory symptoms. Symptoms related to primary cancer can be seen. Anorexia, weight loss, and general weakness are also common.

CT Findings

On CT, miliary metastasis appears as multiple small nodules of a few millimeters in diameter [62]. They are usually of varying in size. The nodules tend to be most numerous in the outer third of the lungs, particularly the subpleural regions of the lower lung zones, and have a random distribution within the secondary pulmonary lobules (Fig. 18.15).

CT–Pathology Comparisons

Hematogenous metastatic pulmonary nodules usually begin to proliferate from tumor emboli in arterioles or capillaries; they tend to have a peripheral distribution in the lungs and a random distribution within the secondary pulmonary lobules [62, 63] (Fig. 18.15).

Patient Prognosis

Prognosis is very poor unless the primary tumor is highly responsive to anticancer chemotherapy.

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