Radiological Evaluation and Clinical Profile of Patients with Miliary Mottling on Chest X-ray: A Cross-Sectional Study

Abstract

Introduction: Miliary mottling on chest X-ray refers to diffuse, tiny nodular shadows resembling millet seeds (~2 mm). It is most commonly caused by miliary tuberculosis (TB). This study aims to evaluate the radiological patterns, differential diagnoses, and clinical profiles of patients with miliary mottling. Methods: A prospective observational study was conducted at the Department of Pulmonary Medicine, of one of the tertiary care hospitals of Ahmedabad, over one year (Feb 2022–Jan 2023). Fifty adult patients (>18 years) presenting with miliary mottling on chest X-ray were enrolled based on inclusion/exclusion criteria. All underwent detailed clinical evaluation, laboratory tests, chest imaging (including HRCT when needed), and were followed up daily until discharge or clinical resolution. Data was recorded using a pretested Case Record Form. Results: Among 50 patients, miliary mottling was most common in males (64%) and in the 21–30-year age group (32%). Sputum AFB was positive in only 8%. Crackles were the most frequent respiratory finding (52%), while 42% had no abnormal chest signs. Radiologically, 92% showed classic miliary patterns. Miliary tuberculosis was the predominant cause (86%), with tubercular meningitis as the most common complication (12%). Conclusions: Chest X-ray remains a crucial, cost-effective initial diagnostic tool. HRCT adds specificity by classifying nodule patterns and aiding in differential diagnosis. Early identification of the etiology helps guide timely treatment.