Another cause of reverse halo sign: Wegener's granulomatosis

Agarwal, Ritesh; Aggarwal, Amita; Gupta, Deepak

doi:10.1259/bjr/61353689

Cited by 38 publications

(21 citation statements)

References 4 publications

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“…The RHS was reported in two cases of Wegener's granulomatosis [40,41], both showing multiple lesions. In one case [40], histopathologic examination with elastic staining for the evaluation of vascular structures revealed necrotizing vasculitis, confirming the diagnosis of Wegener's granulomatosis.…”

Section: Other Diseases Presenting With the Reversed Halo Signmentioning

confidence: 99%

Reversed Halo Sign on Computed Tomography: State-of-the-Art Review

Marchiori

Zanetti

Hochhegger

et al. 2012

Lung

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The reversed halo sign (RHS) is a chest computed tomography (CT) pattern defined as a focal round area of ground-glass attenuation surrounded by a crescent or ring of consolidation. The RHS was first described as being relatively specific for cryptogenic organizing pneumonia but was later observed in several other infectious and noninfectious diseases. Although the presence of the RHS on CT may help narrow the range of diseases considered in differential diagnoses, final diagnoses should be based on correlation with the clinical scenario and the presence of additional disease-specific CT findings. However, frequently a biopsy may be needed to establish the diagnosis. Organizing pneumonia is the most frequent cause of the RHS. This is a distinct clinical and pathologic entity that can be cryptogenic or secondary to other known causes. Morphologic aspects of the halo, particularly the presence of small nodules in the wall or inside the lesion, usually indicate an active granulomatous disease (tuberculosis or sarcoidosis) rather than organizing pneumonia. Immunocompromised patients presenting with the RHS on CT examination should be considered to have an infection until further analyses prove otherwise. Pulmonary zygomycosis and invasive pulmonary aspergillosis are typically seen in patients with severe immunosuppression, most commonly secondary to hematological malignancies. Other causes of the RHS include noninvasive fungal infections such as paracoccidioidomycosis, histoplasmosis, and Pneumocystis jiroveci pneumonia. Furthermore, Wegener's granulomatosis, radiofrequency ablation, and lymphomatoid granulomatosis may also lead to this finding. Based on a search of the PubMed and Scopus databases, we review the different diseases that can manifest with the RHS on CT.

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Section: Other Diseases Presenting With the Reversed Halo Signmentioning

confidence: 99%

Reversed Halo Sign on Computed Tomography: State-of-the-Art Review

Marchiori

Zanetti

Hochhegger

et al. 2012

Lung

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“…The upper respiratory tract is affected in almost all patients, and the lungs and kidneys are involved in 90% and 80% of patients, respectively [34]. Agarwal et al [35] described a patient with Wegener granulomatosis who presented with weight loss, epistaxis, fever, cough and chest pain. The patient had proteinuria due to glomerulonephritis.…”

Section: Wegener Granulomatosismentioning

confidence: 99%

The reversed halo sign: update and differential diagnosis

Godoy¹,

Viswanathan²,

Marchiori³

et al. 2012

BJR

136

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ABSTRACT. The reversed halo sign is characterised by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring. It was first described on high-resolution CT as being specific for cryptogenic organising pneumonia. Since then, the reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, paracoccidioidomycosis, pneumocystis pneumonia, tuberculosis, community-acquired pneumonia, lymphomatoid granulomatosis, Wegener granulomatosis, lipoid pneumonia and sarcoidosis. It is also seen in pulmonary neoplasms and infarction, and following radiation therapy and radiofrequency ablation of pulmonary malignancies. In this article, we present the spectrum of neoplastic and non-neoplastic diseases that may show the reversed halo sign and offer helpful clues for assisting in the differential diagnosis. By integrating the patient's clinical history with the presence of the reversed halo sign and other accompanying radiological findings, the radiologist should be able to narrow the differential diagnosis substantially, and may be able to provide a presumptive final diagnosis, which may obviate the need for biopsy in selected cases, especially in the immunosuppressed population.

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“…More recently the terms "reversed halo sign" or "atoll sign" have been coined [51,52]. In 2003, Kim et al found this sign in 19% of patients with OP and suggested that it was relatively specific for COP [51], however it has now been described in numerous other conditions including sarcoidosis [53] and Wegener's granulomatosis [54]. This sign is not to be confused with the "halo sign" describing a halo of ground glass surrounding a nodule, which is also non-specific and encountered in fungal infection or malignancy [55].…”

Section: Reversed Halo or Atoll Patternsmentioning

confidence: 99%

Organizing pneumonia: a kaleidoscope of concepts and morphologies

Roberton

Hansell

2011

Eur Radiol

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The basic histopathological pattern of organizing pneumonia (OP) is well recognized, but the contexts in which it is encountered continue to increase. In parallel with an appreciation of new causes and associations of OP, an understanding of OP in the spectrum of lung injury and repair has evolved. There is an increasing array of HRCT manifestations of OP, some of which have only recently been described. This article concentrates on new concepts surrounding OP and highlights newly described imaging patterns.

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Another cause of reverse halo sign: Wegener's granulomatosis

Cited by 38 publications

References 4 publications

Reversed Halo Sign on Computed Tomography: State-of-the-Art Review

Reversed Halo Sign on Computed Tomography: State-of-the-Art Review

The reversed halo sign: update and differential diagnosis

Organizing pneumonia: a kaleidoscope of concepts and morphologies

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