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Home > Student Cases > Miliary tuberculosis

Miliary tuberculosis

Clinical data

  • The patient was 6 years old and had just started treatment for spinal tuberculosis.


Post mortem pathology

  • The specimen is the heart and lungs of a child.
  • Numerous pale miliary foci, all ≤ 1mm in diameter, are uniformly distributed throughout both lungs

Numerous pale miliary foci, all ≤ 1mm in diameter, are uniformly distributed throughout both lungs.

Close-up view of lung, showing miliary foci.


Some comments

Millet seeds.

Photo: Elke Wetzig
From: https://commons.wikimedia.org/wiki/File%3AHirsekoerner.jpg 


Pathogenesis

  • Whether in primary or secondary tuberculosis, miliary tuberculosis occurs when organisms draining through lymphatics enter venous blood and there is consequent dissemination of bacteria via the blood stream.
  • This specimen shows miliary pulmonary disease, the result of diffuse spread to the lungs via recirculation through the pulmonary artery.
  • The child may well have had systemic miliary disease (organisms disseminated to the left side of the heart and systemic arterial system) as well. 
  • The two forms of miliary spread can occur independently or together. It is therefore usually a generalised condition, with many organs affected. Death is commonly due to tuberculous meningitis.

Another Example

  • The liver, lungs and spleen from a 3 month old child who died of extensive miliary tuberculosis.
  • The miliary foci are a little larger than in the first example, but they seldom expand beyond a few mm since death intervenes before this can occur. 

The liver, lungs and spleen from a 3 month old child who died of extensive miliary tuberculosis.


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