Miliary tuberculosis is a potentially lethal disease if not diagnosed and treated early. Diagnosing miliary tuberculosis can be a challenge that can perplex even the most experienced clinicians. Clinical manifestations are nonspecific, typical chest radiograph findings may not be evident until late in the disease, high resolution computed tomography shows randomly distributed miliary nodules and is relatively more sensitive.
Sharma, Surendra K, AlladiMohan, and AbhishekSharma. “Challenges in the diagnosis & treatment of miliary tuberculosis.” Indian Journal of Medical Research 135.5 (2012):703-730.
As the clinical symptomatology and physical signs are non-specific, clinicians should have a low threshold for suspecting miliary tuberculosis. Careful physical examination for diagnostic clues such as peripheral lymphadenopathy, cold abscess, pleural effusion, ascites, among others will help in procuring tissue and body fluids for confirming the diagnosis. Fundus examination for detecting choroid tubercles must be done in all patients with suspected miliary tuberculosis as their presence is pathognomonic of miliary tuberculosis. Specific efforts should also be directed at documenting the presence of tuberculosis meningitis as this has therapeutic significance.