This 43-years old man came with fever and dyspnea.
CT scan showed multiple nodules of the same size throughout the lung parenchyma, looking like miliary nodules with one larger lesion in the anterior segment of the right upper lobe. I don’t remember, but sputum or bronchoscopy / lavage was likely negative.

The question was – is this miliary tuberculosis or is this carcinoma with miliary metastases. The nodules are not all of the same size, though they are evenly distributed. The one large focal lesion in the RUL really complicates the matter.

I biopsied the lung nodule with a 20G coaxial biopsy gun. It turned out to be rifampicin resistant tuberculosis.