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Evaluation of solitary pulmonary nodule in human immunodeficiency virus infected patients.

Abstract

BACKGROUND
While the etiologies of solitary pulmonary nodules (SPNs) in immunocompetent patients are well established, common etiology, diagnostic techniques, and guidelines to assess SPNs in patients infected with human immunodeficiency virus (HIV) have not been established.
OBJECTIVE
To define the etiology of SPN in HIV-infected patients and to examine efficacy of diagnostic testing for SPN.
METHODS
We performed a retrospective chart review of HIV-infected patients admitted to a designated acquired immune deficiency syndrome (AIDS) center. Microbiological and histopathological specimens from sputum, bronchoalveolar lavage, and biopsies were analyzed. Charts were fully analyzed from time of admission until definitive diagnosis or loss to follow-up.
RESULTS
During the 10-year observational period, 10 of 5,000 HIV-infected patients admitted to the hospital were diagnosed with SPN via chest radiography or computed tomography (CT). Among these 10 patients, 6 had a definitive diagnosis. Underlying etiologies included infection (5/10) and lung adenocarcinoma (1/10); none were identified in the remaining 4 subjects. Sputum analysis provided no diagnostic value in discovering pathogenesis in any of these cases. Fiberoptic bronchoscopy with bronchoalveolar lavage and transbronchial biopsy were diagnostic in 3 cases, while CT-guided percutaneous transthoracic needle biopsy (PTNB) was diagnostic in 2 cases. One patient required open lung biopsy.
CONCLUSIONS
Etiologies of SPN in HIV-infected patients are varied and difficult to diagnose. In our study, SPN was attributable to infectious etiology in 50% of cases. Sputum analysis was of no diagnostic value. Biopsy is necessary for definitive diagnosis and treatment.

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  • Authors

    Pathak V, Rendon IS, Hasalla I, Tsegaye A

    Institution

    Department of Internal Medicine, St Barnabas Hospital, Bronx, NY, USA. drvikaspathak@gmail.com

    Source

    Respiratory care 57:7 2012 Jul pg 1115-20

    MeSH

    Adult
    Biopsy, Needle
    Bronchoscopy
    Candidiasis
    Comorbidity
    Female
    HIV Infections
    Humans
    Immunocompromised Host
    Lung Neoplasms
    Male
    Middle Aged
    Retrospective Studies
    Solitary Pulmonary Nodule
    Sputum
    Tomography, X-Ray Computed

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    22369939