Single Pulmonary Nodule Management: Experience of a Moroccan Center about 24 Patients

Introduction: The management of single pulmonary nodule remains difficult, since it is of multiple etiologies. The endemicity of tuberculosis and hydatidosis in our context makes the etiological orientation even more difficult. Materials and Methods: This is a retrospective study, involving 24 patients, all operated on for a single pulmonary nodule in the department of thoracic surgery of CHU Hassan II of Fez over a period of 8 years. Results: There were 15 men and 9 women, with an average age of 51 years. 45.4% of patients had a history of known neoplasia. Discovery was fortuitous in 54% of cases. The radiologic diagnosis based on thoracic computed tomography had objectified an isolated nodule in all the patients with a right localization in 71% of the cases It was a solid pulmonary nodule in 91.5% of cases, and a frosted glass appearance in 8.5%. Bronchial fibroscopy was contributory in one case which was a carcinoid tumor. The approach was a conservative postero-lateral thoracotomy in 22 patients. The gesture was atypical resection in 67%, and lobectomy in 24.5% of cases, in the context of centrilobular nodules. The etiologies were dominated by pulmonary metastases in 29% of cases, pulmonary tuberculosis in 21% of cases. The postoperative course was simple in all patients. Conclusion: The pathological antecedents and the characteristics of the nodule on the imaging are essential elements allowing an etiological orientation. However, the pathological study remains the only method to confirm the diagnosis.