Prior history of breast cancer. Presents with myalgias, arthralgias, weight loss, decreased and appetite.
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There is a large right hilar mass predominantly of soft tissue attenuation, however, there are foci of stippled calcification in a circular pattern within it just lateral to the bronchus intermedius. The mass itself encases the right mainstem bronchus as well as right lobar bronchi. There is associated slight narrowing of the encased bronchi.
There is an enlarged right paratracheal lymph node and a calcified node. Significant subcarinal adenopathy is also noted and has displaced the esophagus to the left. An associated large right pleural effusion is present.
Additionally, there are innumerable 1-2mm pulmonary nodules distributed in a random pattern. Several larger nodules measuring up to 2 cm in size are noted primarily within all of lobes on the right consistent with tuberculomas.
The findings are in keeping with miliary tuberculosis. The large right hilar mass is likely conglomerate adenopathy, however, an underlying mass cannot be excluded.
Despite the history of malignancy, this demonstrates miliary opacities suggestive of miliary TB rather than metastases. Bronchial wash positive for AFB.