title: [Miliary tuberculosis with atypical radiographic findings after aorto-coronary bypass surgery].
abstract: Dry cough and exertional dyspnea developed in a 78-year-old man after aorto-coronary bypass surgery for angina pectoris. Chest X-ray films showed small nodular shadows in the upper and middle fields of both lungs. The patient's condition was exacerbated despite treatment with antibiotics. Chest high-resolution computed tomography disclosed small nodular and reticulo-linear shadows predominantly in the interlobular septa and bronchovascular bundles. Transbronchial lung biopsy specimens revealed micro-granulomas with necrosis, suggesting miliary tuberculosis. Antituberculosis drugs were started and the patient's symptoms and radiographic findings gradually resolved. Cases of cellular immunosuppression have beer reported in patients following open-heart surgery that utilized antifical heart and lung apparatus. Such procedures, together with hemodialysis, deserve consideration as potential risk factors for miliary tuberculosis.
authors.affiliation: Department of Internal Medicine, National Sanatorium Seiranso Hospital, Ibaraki, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Endo
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: M
authors.initials: M
authors.lastname: Nakayama
authors.forename: H
authors.initials: H
authors.lastname: Ohse
authors.forename: S
authors.initials: S
authors.lastname: Watanabe
authors.forename: S
authors.initials: S
authors.lastname: Tamai
authors.forename: S
authors.initials: S
authors.lastname: Hasegawa
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000601:surgery; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006801:Humans; D008297:Male; D011859:Radiography; D014391:Tuberculosis, Miliary / Q000000981:diagnostic imaging*