• Vikas Pathak, Iliana Samara Hurtado Rendon, Irida Hasalla, and Adey Tsegaye.
• Department of Internal Medicine, St Barnabas Hospital, Bronx, NY, USA. drvikaspathak@gmail.com
• Resp Care. 2012 Jul 1;57(7):1115-20.

BackgroundWhile 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.ObjectiveTo define the etiology of SPN in HIV-infected patients and to examine efficacy of diagnostic testing for SPN.MethodsWe 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.ResultsDuring 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.ConclusionsEtiologies 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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