Multiple Nodular Shadows and Miliary Pattern

CLINICAL DIAGNOSTIC MANUAL

Multiple nodular shadows and a miliary pattern on a chest X-ray or computed tomography (CT) indicate the presence of small, dispersed opacities throughout the lungs.

This pattern can result from various pathologies that cause haematogenous or lymphatic dissemination of infectious agents, neoplasms, or inflammatory processes. The differential diagnosis is broad and requires detailed clinical and laboratory evaluation to determine the underlying cause.

Pathology	Clinical Symptoms and Signs	Suspected Diagnosis	Confirmatory Diagnosis
Metastasis	Cough, dyspnoea, chest pain, weight loss	History of cancer in another organ, respiratory symptoms	Chest X-ray, chest CT, needle biopsy, PET scan
Miliary tuberculosis	Persistent cough, fever, night sweats, weight loss	History of tuberculosis exposure, chronic symptoms	Chest X-ray, chest CT, tuberculin test, sputum culture
Sarcoidosis	Cough, dyspnoea, fatigue, weight loss, lymphadenopathy, erythema nodosum	History of systemic symptoms, lymphadenopathy	Chest X-ray, chest CT, tissue biopsy, angiotensin-converting enzyme (ACE) levels
Secondary to varicella	Cough, fever, characteristic skin rash, dyspnoea	History of varicella infection, respiratory symptoms	Chest X-ray, chest CT, varicella-zoster serological tests
Mitral stenosis with pulmonary hypertension	Dyspnoea, fatigue, orthopnoea, palpitations, peripheral oedema	History of heart disease, respiratory symptoms	Chest X-ray, echocardiogram, chest CT, cardiac catheterisation
Pneumoconiosis	Cough, dyspnoea, fatigue, occupational history of exposure to mineral dusts	Occupational history of dust exposure, chronic symptoms	Chest X-ray, chest CT, pulmonary function tests, lung biopsy