Miliary Nodules: Not Always Tuberculosis

• Published in: Annals of the American Thoracic Society Vol. 14; no. 12; pp. 1858 - 1860
• Main Authors: Kimmig, Lucas, Bueno, Juliana
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 01.12.2017
• Subjects: Adenocarcinoma of Lung - diagnosis; Adenocarcinoma of Lung - secondary; Biopsy; Bronchoscopy; Diagnosis, Differential; Fungal infections; Humans; Laboratories; Lumbar Vertebrae; Lung - diagnostic imaging; Lung cancer; Lung diseases; Male; Medical imaging; Metastasis; Middle Aged; Mutation; Neoplasm Metastasis; Nervous system; Patients; Radiography, Thoracic; Spinal Neoplasms - diagnosis; Spinal Neoplasms - secondary; Tomography, X-Ray Computed - methods; Tuberculosis; Tuberculosis, Miliary - diagnosis; United States > US; China
• DOI: 10.1513/AnnalsATS.201706-436CC
• ISSN: 2329-6933

Mutations in the epidermal growth factor receptor (EGFR) gene and rearrangements of the ALK gene are two of the most common driver mutations in lung adenocarcinoma. According to this patient's risk factors, the most likely diagnostic considerations are miliary tuberculosis, fungal infection (e.g., histoplasmosis or blastomycosis given our midwestern location), and metastatic disease. The mass in the lumbar spine that caused the initial symptoms was confirmed to represent a distant metastasis of a primary lung cancer.