Miliary opacities (lungs)

Changed by Yuranga Weerakkody, 18 Mar 2017

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The term miliary opacities refers to innumerable, small 1-4 mm pulmonary nodules scattered throughout the lungs. It is useful to divide these patients into those who are febrile and those who are not.

Additionally, some miliary opacities are very dense, narrowing the differential - see multiple small hyperdense pulmonary nodules.

Pathology

Aetiology

The causes can be broadly sub grouped dependent on whether or not the patient is febrile.

Afebrile

infection
- tuberculosis (often febrile but may be afebrile)
  - miliary tuberculosis
- fungal (often febrile)
  - immunocompromised or elderly patients may be afebrile
- healed varicella pneumonia
miliary metastases
sarcoidosis: miliary sarcoidosis⁸
pneumoconioses
- silicosis
- coal workers pneumoconiosis
pulmonary haemosiderosis
hypersensitivity pneumonitis
Langerhans cell histiocytosis (LCH)
multifocal micronodular pneumocyte hyperplasia (MMPH)
pulmonary alveolar proteinosis
- small acinar opacities can mimic a miliary pattern ⁶

Febrile

infection
- tuberculosis
- fungal
- viral pneumonitis
- nocardosis
- salmonella
hypersensitivity pneumonitis (mild fever if any)

History and etymology

The term miliary stems from millet seed, a term used to describe a group of small-seeded species of cereal crops or grains, widely grown around the world for food and fodder ⁵.

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