Reversed halo sign

Marchiori, Edson; Zanetti, Gláucia; Hochhegger, Bruno

doi:10.1590/s1806-37562015000000235

Cited by 9 publications

(7 citation statements)

References 1 publication

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“…It can be observed in a variety of infectious and noninfectious diseases; among fungal infections, it is more common in paracoccidioidomycosis and angioinvasive fungal infections such as aspergillosis, zygomycosis and fusariosis ( 31 , 32 ) . In an attempt to narrow the differential diagnosis of diseases presenting with the reversed halo sign, findings of internal reticulation, peripheral halo thickness > 1.0 cm and pleural effusion favor the diagnosis of an angioinvasive fungal infection over that of organizing pneumonia, within the appropriate clinical context of immunosuppression ( 33 , 34 ) . A variation of the reversed halo, with nodular margins ( Figure 5 ), can be seen in paracoccidioidomycosis, as well as in other granulomatous diseases such as tuberculosis ( 31 , 33 , 35 ) .…”

Section: Tomographic Patterns Of Thoracic Involvementmentioning

confidence: 99%

Tomographic assessment of thoracic fungal diseases: a pattern and signs approach

et al. 2018

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Pulmonary fungal infections, which can be opportunistic or endemic, lead to considerable morbidity and mortality. Such infections have multiple clinical presentations and imaging patterns, overlapping with those of various other diseases, complicating the diagnostic approach. Given the immensity of Brazil, knowledge of the epidemiological context of pulmonary fungal infections in the various regions of the country is paramount when considering their differential diagnoses. In addition, defining the patient immunological status will facilitate the identification of opportunistic infections, such as those occurring in patients with AIDS or febrile neutropenia. Histoplasmosis, coccidioidomycosis, and paracoccidioidomycosis usually affect immunocompetent patients, whereas aspergillosis, candidiasis, cryptococcosis, and pneumocystosis tend to affect those who are immunocompromised. Ground-glass opacities, nodules, consolidations, a miliary pattern, cavitary lesions, the halo sign/reversed halo sign, and bronchiectasis are typical imaging patterns in the lungs and will be described individually, as will less common lesions such as pleural effusion, mediastinal lesions, pleural effusion, and chest wall involvement. Interpreting such tomographic patterns/signs on computed tomography scans together with the patient immunological status and epidemiological context can facilitate the differential diagnosis by narrowing the options.

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Section: Tomographic Patterns Of Thoracic Involvementmentioning

confidence: 99%

Tomographic assessment of thoracic fungal diseases: a pattern and signs approach

et al. 2018

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“…Although the RHS is considered a finding with low specificity, the presence of nodules on the wall of or within the halo (nodular RHS) and the presence of a reticular pattern within the halo (reticular RHS) are morphological features that can narrow the differential diagnosis 24 26 The nodular RHS is found in active granulomatous diseases, especially tuberculosis and sarcoidosis 27 .…”

Section: Discussionmentioning

confidence: 99%

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

et al. 2019

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Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

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“…However, it was subsequently described in a variety of pulmonary diseases [1,2] , both infectious and non-infectious, including tuberculosis. Some authors are attempting to better characterise this sign, in order to aid differential diagnosis, and they have found that the presence of nodules on the wall of or within the halo (nodular RHS) is generally seen in active granulomatous disease, such as tuberculosis [3] . Nevertheless, the presence of the RHS is still considered an important clue to the diagnosis of OP, especially in immunocompetent patients [4,5] .…”

Section: Discussionmentioning

confidence: 99%

The Reversed Halo Sign: Not Such a Specific Sign of Organising Pneumonia

Oliveira

Carvalho

Rosa

et al. 2019

European Journal of Case Reports in Internal Medicine

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The reversed halo sign is defined as a focal rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation. It is a relatively rare sign and initially considered a specific sign of organising pneumonia. We report the case of a 55-year-old female who was being followed-up in a pulmonology consultation due to a 6 mm nodule which required vigilance. On a re-evaluation chest CT scan, besides a stable 6 mm nodule, a 36 mm mass with the reversed halo sign was diagnosed. The presence of the reversed halo sign misled the multidisciplinary team into the diagnosis of organising pneumonia and initiation of corticotherapy was suggested. However, after further investigation, a final diagnosis of pulmonary tuberculosis was made. Even though this sign is relatively rare, and still considered an important clue to the diagnosis of organising pneumonia in immunocompetent patients, other causes must be excluded before starting treatment.LEARNING POINTSThe reversed halo sign (RHS) is defined as a focal rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation. It is a relatively rare sign, and still considered an important clue to the diagnosis of organising pneumonia (OP). However, the RHS has been described in other pulmonary diseases.The diagnosis of OP depends upon the demonstration of typical histopathologic features, usually through lung biopsy, and exclusion of other diseases which led, in our case, to a final diagnosis of pulmonary tuberculosis.

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Reversed halo sign

Cited by 9 publications

References 1 publication

Tomographic assessment of thoracic fungal diseases: a pattern and signs approach

Tomographic assessment of thoracic fungal diseases: a pattern and signs approach

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

The Reversed Halo Sign: Not Such a Specific Sign of Organising Pneumonia

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