I- Introduction :
1- Definition : opacity micronodular whose diameter is 1.5 or 3 mm can be localized or diffuse, with reticular images or reticulonodular.
2- Circumstances of discovery : respiratory symptoms or during a general disease.
II- positive Dgc :
radiological
III- dgc differential :
False images of miliary :
- Error-Technique : Apnea, old cliche, expiration will increase the images reticular nodular.
- Obesity, pregnancy.
IV- etiological Dgc :
Requires a careful balance, whether clinical, radiological, breathing pattern, or even lung biopsy.
1- infectious miliary :
– Tuberculosis.
– bacterial miliary : staph : flaky appearance.
– sepsis Table.
– virose : nodule.
– Miliaire mycosique : may calcify.
– Pneumocystose carinii.
– At the ID (page), rapidly changing, cardiorespiratory failure.
– Sd de Loffler (dry rate, hyper eosinophilia, images labile).
2- mechanical miliary :
– lung heart : edema, IVG, RM reticular nodular ( the bases are more infused the top).
+ TRT : digitalis diuretics, RM (auscultation).
– hemosiderosis ( secondary to RM : ATED de RM, -OAP repeated sub ->picture miliary.
– Granita post hemoptoic.
3- Miliary malignancies :
– Lymphangite carcinomateuse.
– Ostéosarcome : blood-borne invasion and lymphogenic follows the hematogenous
– kc secondary image.
- miliary.
- Opacity single round.
- multiple opacity round.
- Opacity-miliary carcinomatosis.
- ADP.
- Lymphangite.
- Pleurale.
– Kc to be, the,
– Kc stomach, pancreas, larynx and bronchi.
– Carcinose miliaire : image balloon release.
– Hodgkin's disease are associated ADP.
V- To behave :
1- acute table : miliary with acute table.
– Pneumo hospitalization or Rea.
– general acute miliary
- febrile => TBC.
- Pa02, saturation, dyspnea.
- Criteria gravity : respiratory, cardiovascular
- Clinique.
- for clinique.
- 02therapy.
– Among young adults : miliary tuberculosis
– Assessment of extension
– Fundus : THIS.
– PL in the second position.
– Blood culture.
– FNS .
2- cold miliary : (chronicity).
- miliary fever or respiratory distress.
- Fistula ADP often.
3- miliary tuberculosis :
- Adult : widespread : secondary kc
- localized : infectious, bacterial or viral.
4- miliary + ADP mediastinal :
- TBC
- Sarcoïdose
- Hodgkin
5- miliary + abnormal cardiac silhouette :
- RM, IVG
6- miliary + professional context :
- silicone.
- asbestosis.
- allergic alveolitis (Lung farmer and breeder birds).
7- Miliary highly radiopaque especially scanner :
- Miliaire TBC calcifiée.
- idiopathic hemosiderosis.
- Cracinose secondary kc, ostéosarcome.
- Micro alveolar lithiasis.
IF NOT DGC DOSE : DISCUSS THE LUNG BIOPSY.