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This is why we tell kids to not run with things in their mouths...
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Credit: anonymous
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A little bit of #mixedreality with the new #hololens2; a little bit #virtualreality performing a #kyphoplasty. .
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Siemens Magnetom Terra 7T
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Have a look at the X-Ray and swipe left for an explanation....
MILIARY TB - NORMAL VESSELS OR ABNORMAL?
As a Chest Radiologist one of the trickiest parts of my job is deciding whether I’m looking at normal vascular markings on a CXR or whether what I’m seeing relates to tiny nodules or interstitial lung disease
A useful tip is to look out to the periphery of the lung - if there are no markings there you can be fairly sure you are looking simply at normal vessels. Small nodules at the periphery can relate to miliary nodules as we see here whilst ‘lines’ or reticulation at the edge of the lung can represent an interstitial lung disease
This isn’t an all encompassing rule but it has certainly helped me make the right call in many situations
Once you’ve decided you can see tiny nodules that are real, you then need to then think about what the underlying diagnosis is
If the patient is sick with sepsis consider miliary TB which is the diagnosis here
It may not always be TB however! There is a differential diagnosis and to make things confusing the list for miliary nodules is slightly different to the one I posted a few days ago which looks at nodules in general
The mnemonic I use is MICES (obviously not grammatically correct!)
▫️Miliary metastases - consider thyroid, renal cell, melanoma
▫️Infection - TB and fungal
▫️Coal workers pneumoconiosis and other inhalation disease
▫️Extrinsic allergic alveolitis - now termed hypersensitivity pneumonitis
▫️Sarcoid
Hopefully this post will help you make the right call! If you found it useful let me know in the comments!
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