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Extrapulmonary tuberculosis Miliary tuberculosis :. This occurs following widespread haematogenous dissemination of tubercle bacilli. If the pulmonary artery is involved, spread is limited to lung. If pulmonary vein is involved, spread is systemic. Onset in the young is usually acute whereas in the elderly it is insidious. General symptoms are fever, weakness, malaise, loss of weight, dry cough and breathlessness. Alternatively, the presenting symptoms may be those of associated tuberculosis meningitis: gradual onset listlessness or irritability, headache and sometimes seizures or cranial nerve abnormalities. A pathognomonic sign is the presence of choroidal tubercles. Chest X-ray classically shows uniformly distributed nodules but may be normal.
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