A 43-Year-Old Man with a Cough, Body Aches, and Fever

Differential Diagnosis

• Pneumothorax
• Miliary lung pattern
• Lobar pneumonia
• Aortic dissection
• Cardiomegaly

Diagnosis

The image shows bilateral diffuse small nodules less than 4 mm in diameter—a miliary lung pattern. This could be indicative of infection or nodular diseases. (As regular readers know, Insights in Images resolutions typically display arrows to indicate the most salient portion of an x-ray. In this case, however, the process is so diffuse that adding arrows where needed would merely obscure the image.)

Learnings/What to Look for

• Consider whether patients are febrile or afebrile
  • Febrile patients may have infection (tuberculosis, fungal, viral pneumonitis, nocardiosis) or hypersensitivity pneumonitis (low-grad fever, if present)
  • Afebrile patient should be assessed for infection, miliary metastatic disease, or other nodular diseases such as sarcoidosis and pneumoconiosis

Pearls for Urgent Care Management and Red Flags for Transfer

• The patient should be assessed for signs of respiratory distress, hypoxemia, weight loss, night sweats or other signs of infection including tuberculosis

Acknowledgement: Image and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).