A Study on Etiology and Diagnostic Modalities of Cases With Solitary Pulmonary Opacity in Chest Roentgenogram

Abstract

INTRODUCTION: In various mass screening programmes, 0.09-2% of chest radiographs have revealed solitary pulmonary nodules. This continues to pose a diagnostic challenge and therefore the signicance of its proper evaluation to differentiate between benign and malignant causes. The study was carrie MATERIALS AND METHODS: d out in the Department of Respiratory Medicine of IPGMER, Kolkata for a period of one & half year (November 16 to May 2018). Help was also sought from various departments of IPGMER, specially the Departments of Pathology, Microbiology, Cardiothoracic surgery and Radiotherapy. Fine needle aspiration cytology of lung opacity under guidance of computerized tomography was performed in Radiology Section of the Bangur Institute of Neurology, Calcutta, Department of Radiotherapy, IPGMER and The CT-Scan Centre of Medical College, Kolkata. A total of 73 cases showing solitary pulmonary opacity and obeying the selected criteria were selected for the study of which 56 cases are being evaluated in this study as 17 cases were either lost to follow-up or data was incomplete and hence were excluded. The study showed RESULT AND ANALYSIS: bronchogenic carcinoma as by far the most common cause of solitary pulmonary opacity occurring in 45% of the total cases. Majority of the cases of bronchogenic carcinoma were of squamous cell variety (48%) followed by adenocarcinoma (36%). Small cell carcinoma (4%) and anaplastic carcinoma (12%) were less common. Among the benign causes, tuberculoma was the commonest cause seen in 21.4% cases followed by metastasis from other sites (9%). Solitary pulmonary opacity due to bronchogenic carcinoma was seen more in elderly subjects (Mean age of the subjects with bronchogenic carcinoma was 58.9 years while for tuberculoma & hydatid cyst cases the mean ages were 43.3 years and 41 years respectively). The present study showed that meticulous clinical evaluation, careful study of c CONCLUSION: hest roentgenogram coupled with judicious use of investigations like ber optic bronchoscope andCT guided aspiration cytology make it possible to diagnose the etiology of solitary pulmonary opacitieswithoutresortingtomajorsurgicalprocedures.Althoughthis doesnotunderestimatethe needforthoracotomy whichisthenalanswertotheproblemofundiagnosedsolitarypulmonary opacity, The present study can be regarded as yet another illustration of the current trend of evaluation of pulmonary opacities by increasing use of non-invasive investigation procedures bases on recent technologicaladvances.