A solitary pulmonary nodule is a single, well-circumscribed nodule seen on a chest X-ray without enlarged lymph nodes. It can be benign or malignant. The approach is to compare to old chest X-rays to see if the nodule has changed in size over two years. If low risk, follow with CT scans every two months for two years. Intermediate risk undergoes CT and biopsy or PET scan, with excision if malignant and follow up if benign. High risk nodules are removed. Peripheral nodules are biopsied transthoracically while central nodules may use bronchoscopy, but open lung biopsy is superior. Bronchoscopy biopsy has drawbacks of non-

1. Solitary pulmonary nodule
Single,well-circumscribednodule seenincidentallyonCXRwithouthilarormediastinal LNs.
Differential diagnosis:
Benign Malignant
Infection: Abscess,TB, hydatid cyst Bronchogenic cancer
Inflammation:Rheumatoid nodule, wegener’s Metastasis
Vascular:Pulmonary infarction,AVM Lymphoma
Simple cyst Carcinoid
Benign neoplasm: hamartoma --
What is a potentiallybenignnodule?
1. Size < 1 cm
2. Shape:round,well-circumscribed
3. Central callcification
4. No change in2 years
5. Age < 50 years
6. Notsmoker
What is the approach to a solitary lungnodule?
1. Findan oldCXR  if the nodule notchangedin2 years  follow yearly
 if the nodule changed/new nodule/noCXRfound  godown
2. Determine risk  lowrisk  do CT Q 2 monthsfor 2 years
 intermediate risk  CT& biopsy orPET  if malignant excise
 benign F/UQ2 mnth
 highrisk  remove it
How to take a biospy insolitary lung nodule?
1. Peripheral nodule  transthoracicbiopsy
2. Central nodule bronchoscopy butopenlungbiopsyissuperior
What are the drawbacks of bronchoscopy-biopsy?
1. Non-specificresultsin10%
2. Done blindly