Jakeer Hussain Shaik

Background: The diagnosis, classification and management of a solitary pulmonary nodule (SPN) have always been a challenge for the clinicians and radiologists. All SPNs should be considered malignant until proven otherwise. Malignancy risk rises with increasing nodule size. Hence evaluation of the various clinical and pathological presentations of SPN is essential. Methodology: A hospital-based cross-sectional study was conducted in a tertiary care teaching hospital on 70 cases of SPN. Chest X-ray, CT (Computed Tomography) and bronchoalveolar lavage were used for analysing the SPN. IBM SPSS version 22 was used for statistical analysis. Results: The incidence of SPN in this study was 1.33 per 1000 population. The total number of chest X-rays screened were 5263. The most common risk factors were exposure to PTB (Pulmonary Tuberculosis) or history of PTB (97.1%), followed by smoking (81.4%), history of STD (32.9%). Dry cough was the most common symptom among (20%). In X-ray, in 57.1% of subjects, the upper lobes were involved. Lesions were central in 41.4% while peripheral in 58.6%. The proportion of nodules with 1.1 to 2cm and above 2 cm was 22.85% and 77.15%. No calcification was found in 78.6% of nodules. In SPN the most common final diagnosis was tuberculosis (14.3%) followed by Pneumonia/abscess (8.6%) and Squamous cell carcinoma and Pseudotumor (5.71% each). 20% of SPN were malignant. 11.42% of nodules turned out to be primary lung malignancy while 1.42% were metastasis and 7.1% were small cell carcinoma. Conclusions: SPN is a common incidental and radiologic finding. Some internal features of SPNs can help in differentiating benign from malignant lesions. Despite radiological imaging, still, a large number of nodules have to be described as “indeterminate” and advanced and often more invasive techniques are needed for further work-up. Keywords: Solitary pulmonary nodule (SPN); Malignancy, Incidence; Bronchoalveolar lavage.