title: 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.
authors.affiliation: Department of Internal Medicine, St Barnabas Hospital, Bronx, NY, USA. drvikaspathak@gmail.com
authors.forename: Vikas
authors.initials: V
authors.lastname: Pathak
authors.forename: Iliana Samara Hurtado
authors.initials: IS
authors.lastname: Rendon
authors.forename: Irida
authors.initials: I
authors.lastname: Hasalla
authors.forename: Adey
authors.initials: A
authors.lastname: Tsegaye
mesh_terms: D000328:Adult; D001707:Biopsy, Needle; D001999:Bronchoscopy; D002177:Candidiasis / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D016867:Immunocompromised Host; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D013183:Sputum / Q000737:chemistry; D014057:Tomography, X-Ray Computed