17059              TUBERCULOMA WITH MILIARY TUBERCULOSIS

The patient was a woman aged 82 who was admitted with general deterioration and loss of appetite.  She had been breathless for 3 days but had no cough.  Chest X-ray showed no abnormalities in the lung fields.  The heart was enlarged.  The temperature was continually elevated and swinging to a maximum of 102o.  She died after a few days.  At postmortem signs of congestive cardiac failure were present and miliary tuberculosis was also found.

The specimen is of the right lung sectioned to show a rounded partly encapsulated tuberculoma 3 cms in diameter in the posterior segment of the upper lobe.  The remainder of the lung is closely and uniformly studded by small miliary tubercules less than 1mm in diameter.  These have obviously arisen by bloodstream invasion but the mechanism of invasion cannot now be identified.  The autopsy protocol does not describe the state of the left lung nor of the hilar glands.  Other organs such as the thoracic duct, liver, kidney and brain were apparently not affected.  Histology showed typical miliary tubercles containing acid-fast bacilli.