Frequency and predictors of miliary tuberculosis in patients with miliary pulmonary nodules in South Korea: a retrospective cohort study.
BACKGROUND
Miliary pulmonary nodules are commonly caused by various infections and cancers. We sought to identify the relative frequencies of various aetiologies and the clinical and radiographic predictors of miliary tuberculosis (TB) in patients with miliary pulmonary nodules.


METHODS
We performed a retrospective cohort study of patients who presented with micronodules occupying more than two-thirds of the lung volume, based on computed tomography (CT) of the chest, between November 2001 and April 2007, in a tertiary referral hospital in South Korea.


RESULTS
We analyzed 76 patients with miliary pulmonary nodules. Their median age was 52 years and 38 (50%) were males; 18 patients (24%) had a previous or current malignancy and five (7%) had a history of TB. The most common diagnoses of miliary nodules were miliary TB (41 patients, 54%) and miliary metastasis of malignancies (20 patients, 26%). Multivariate analysis revealed that age <or=30 years, HIV infection, corticosteroid use, bronchogenic spread of lesions, and ground-glass opacities occupying >25% of total lung volume increased the probability of miliary TB. However, a history of malignancy decreased the probability of miliary TB.


CONCLUSIONS
Miliary TB accounted for approximately half of all causes of miliary pulmonary nodules. Young age, an immune-compromised state, and several clinical and radiographic characteristics increased the probability of miliary TB.
Jin
Sang-Man
SM
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. smj0919@medimail.co.kr
Lee
Hyun Ju
HJ
Park
Eun-Ah
EA
Lee
Ho Yun
HY
Lee
Sang-Min
SM
Yang
Seok-Chul
SC
Yoo
Chul-Gyu
CG
Kim
Young Whan
YW
Han
Sung Koo
SK
Shim
Young-Soo
YS
Yim
Jae-Joon
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000209:etiology*; D015999:Multivariate Analysis; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D014391:Tuberculosis, Miliary / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult