Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis

Khan, Dawlat; Danjuma, Mohammed; Saddique, Muhammad; Murshed, Khaled; Yassin, Mohamed A

doi:10.1159/000505685

Cited by 12 publications

(20 citation statements)

References 10 publications

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“…High-resolution CT-chest is often useful to narrow down the differential diagnosis. The centrilobular and perilymphatic pattern indicates infectious bronchiolitis and sarcoidosis, respectively, while the random pattern is seen in hematogenous cancer metastasis [ 7 ]. Our patient had numerous small nodular bilateral pulmonary infiltrates on CXR and a random nodular distribution pattern on the CT chest.…”

Section: Discussionmentioning

confidence: 99%

“…The close clinical and radiological presentation of miliary pulmonary TB and adenocarcinoma lung presenting as miliary shadows on chest images poses a diagnostic challenge. Without a tissue biopsy, it may lead to misdiagnosis, serious sequelae, and poor outcomes due to completely different treatment modalities [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…It inclines to involve the thoracic and lumbar spine and may mimic Pott’s disease [ 5 , 6 ]. Adenocarcinoma of the lung, among others, is a potential differential diagnosis of miliary shadows on chest imaging [ 7 ]. Because of close radiological resemblance, it is often a challenge to differentiate Pott’s disease from primary or early metastatic spinal tumors.…”

Section: Introductionmentioning

confidence: 99%

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Metastatic Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis and Pott’s Disease

Khan

Saddique

Paul

et al. 2021

Cureus

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Tuberculous spondylitis (Pott’s disease) is among the frequent extra-pulmonary presentations of tuberculosis (TB). The global incidence of lung adenocarcinoma is on the rise, and it is a rare differential diagnosis of miliary shadows on chest imaging. It has a predilection to metastasize to ribs and spine in particular. There is a very close clinical and radiological resemblance in the presentation of spinal metastasis of lung cancer and Potts’s disease. It poses a diagnostic challenge to clinicians particularly in TB endemic areas to arrive at an accurate diagnosis, leading to disease progression and poor outcome. We report a 54-year-old female patient presented with constitutional symptoms of on and off fever and back pain. Her chest X-ray revealed miliary shadows, and acid-fast bacilli (AFB) sputum smear and TB polymerase chain reaction (PCR) test came negative; radiological diagnosis of tuberculous spondylitis was done on computerized tomography (CT) chest and magnetic resonance imaging (MRI) spine. Subsequent bronchoscopy and bronchoalveolar lavage (BAL) cytology showed malignant cells and CT-guided lung biopsy confirmed lung adenocarcinoma with spinal and brain metastasis. Despite being started on chemo-immunotherapy and radiotherapy her outcome was poor due to advanced metastatic disease. This case highlights the significance of considering metastatic adenocarcinoma of the lung a rare but ominous possibility in the differential diagnosis of miliary shadows on chest imaging. Early bronchoscopy and biopsy must be considered in all patients presenting with miliary pulmonary lesions and spinal lesions to make a correct diagnosis, preventing an unnecessary delay in starting proper treatment and poor outcome. It also emphasizes the importance of better understanding the different radiographic features of the two common mimics, spinal tuberculosis, and metastatic spinal tumors.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Metastatic Adenocarcinoma of the Lung Mimicking Miliary Tuberculosis and Pott’s Disease

Khan

Saddique

Paul

et al. 2021

Cureus

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“…However, the CT scan findings in those two cases did not meet the nodule size requirement in the above definition of miliary pulmonary metastasis. 5 , 6 …”

Section: Discussionmentioning

confidence: 99%

Alectinib for Miliary Lung Metastasis in ALK-Positive Lung Adenocarcinoma

Satoh¹,

Okuma²,

Kashima

et al. 2021

OTT

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Background Miliary pulmonary metastasis characterized by tiny nodules is a rare metastatic pattern in advanced non-small cell lung cancer (NSCLC) and is usually seen in patients harboring an EGFR mutation, and amylase-producing lung cancer is highly uncommon and rarely reported in NSCLC patients who have an EGFR mutation. Case A 32-year-old Japanese female was found to have miliary pulmonary nodules throughout both lung fields on a chest x-ray examination during an annual health check-up. Further examination by computed tomography (CT) revealed diffuse, bilateral, miliary nodules. Blood tests showed no increased tumor marker levels, but there was a significantly increased serum amylase level. A diagnosis of ALK -rearranged adenocarcinoma was made based on the results of a mediastinal lymph node biopsy obtained by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Treatment with alectinib resulted in rapid regression of the CT shadows and a reduction in the patient’s serum amylase level. Conclusion We have reported a case of ALK -rearranged NSCLC with a miliary pulmonary metastasis pattern that was sensitive to alectinib and in which the serum amylase level decreased in response to treatment with alectinib. Young patients with miliary pulmonary metastasis should be checked for all driver mutations.

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“…Although miliary tuberculosis is the most known cause of miliary infiltrates on chest imaging, other differential diagnoses including pneumoconiosis, fungal infections, sarcoidosis, histoplasmosis, primary lung cancer, and hematogenous spread of non-pulmonary malignancies [12] can mimic this radiographic finding. Rarely, primary lung adenocarcinoma could be the etiology of miliary nodules on chest radiography [13]. While renal cancers are the most likely solid organ malignancies that can manifest with a miliary pattern on chest imaging [14], primary cancers of the thyroid, melanoma, trophoblastic tumors and sarcomas also can display a similar radiologic feature.…”

Section: Discussionmentioning

confidence: 99%