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Solitary pulmonary nodule in the southwest. Coccidioidoma or carcinoma?

The diagnostic approach to the patient with a solitary pulmonary nodule can be challenging. The location, size of lesion, presence of calcification, age of patient, associated habits such as smoking, and other factors, provide clinical information of diagnostic value but do not alter the necessity for either microbiologic culture and/or histopathologic examination of tissue for confirmation of the diagnosis. In general, the approach should proceed from the least to most invasive procedure, with higher yield procedures being performed early. Newer imaging techniques such as chest computed tomography, as well as techniques such as bronchoscopy and needle biopsy, are tools that have enabled clinicians to procure the rewards of diagnosis without the morbidity of a major surgical procedure. Cytology and the culture of sputum and pulmonary secretions also help to avoid open-chest procedures. In this era of cost containment and diagnosisrelated groups (DRGs), it is important to examine the potential reduction