The miliary pattern in chest radiography is very rare in patients with primary lung cancer.4,5 Here is a rare case of a young, female patient with non-small cell carcinoma of the lung presenting as miliary mottling. Case Description A 28-year-old housewife presented with a history of fever, cough, and chest pain of 15 days duration. The patient was apparently normal 15 days prior to admission, when she developed a fever that was gradually progressive, moderate to high grade, and associated Inhibitors,research,lifescience,medical with chills. She had cough associated with mucoid expectoration, which was non-blood tinged. She also had a pricking type of chest pain, which was central and non-radiating.
The patient was not a diabetic or a hypertensive, and nor was she a known case of ischemic heart disease or tuberculosis. Also, she was not a selleckchem smoker or an alcoholic. There Inhibitors,research,lifescience,medical was no family history of tuberculosis or close contact with tuberculosis. On examination, the patient was afebrile with a pulse of 90 beats per minute and blood pressure of 130/80 mmHg. General physical examination did not reveal pallor, icterus, clubbing, cyanosis, edema, or lymphadenopathy.
Inhibitors,research,lifescience,medical Thyroid examination was within normal limits, and respiratory, cardiovascular, abdominal, and central nervous systems were clinically normal. Hemogram revealed a total count of 11,900 /mm3. Additionally, the differential count was within normal limits and the erythrocyte sedimentation rate (ESR) was 35 mm/h. Sputum acid Inhibitors,research,lifescience,medical fast bacilli (AFB) (3 samples) were negative. A Gram stain showed plenty of epithelial cells, pus cells, Gram-positive cocci, and gram-negative bacilli. Human immunodeficiency virus (HIV) was non-reactive. Liver function and renal function tests were within normal limits. The Mantoux test was negative. Chest X-ray showed miliary
mottling (figure 1). Thoracic computed tomography (CT) revealed a small, mildly enhancing, nodular lesion containing central density involving the posterior basal segment of the left lower lobe with a few enlarged pretracheal, retrocaval, aortopulmonary, and right hilar lymph nodes. Inhibitors,research,lifescience,medical In addition, numerous tiny nodular lesions were scattered much in both lung fields and there was no pleural effusion. The CT features were suggestive of tuberculoma with miliary tuberculosis (figure 2). Figure 1 Chest radiograph, showing miliary mottling Figure 2 Thoracic computed tomography, demonstrating a small, mildly enhancing, nodular lesion containing central density (arrow) with a few enlarged pretracheal, retrocaval, aortopulmonary and right hilar lymph nodes. Additionally, numerous tiny nodular lesions … CT-guided fine needle aspiration cytology (FNAC) was performed to confirm the diagnosis of tuberculosis. However, FNAC sprang a surprise by revealing tumor cells arranged in an acinar pattern with a hyperchromatic nucleus with a background of hemorrhage and necrosis, suggestive of a lower-lobe, left lung non-small cell carcinoma (adenocarcinoma) (figure 3).