Pulmonary tuberculosis associated with the reversed halo sign on high-resolution CT

Marchiori, Edson; Grando, R D; Santos, C E Simões Dos; Balzan, Letícia; Zanetti, Gláucia; Mano, Cláudia Mauro; Gutierrez, Renato Soares

doi:10.1259/bjr/22699201

Cited by 38 publications

(17 citation statements)

References 13 publications

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“…Additional findings included centrilobular nodules and subcarinal and left hilar lymphadenopathy [16]. In another case of tuberculosis with the RHS in an adult female, the associated CT findings included pulmonary nodules and areas of consolidation with cavitation [17]. A peculiarity reported in a patient with active tuberculosis and the RHS, and also mentioned in other granulomatous infectious processes including schistosomiasis and cryptococcosis, is the nodular appearance of the ring in the RHS, which has been histologically proven to correlate to granulomas, therefore assisting in the differentiation of active granulomatous disease vs organising pneumonia ( Figure 4) [12,18].…”

Section: Tuberculosismentioning

confidence: 99%

The reversed halo sign: update and differential diagnosis

Godoy¹,

Viswanathan²,

Marchiori³

et al. 2012

BJR

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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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Section: Tuberculosismentioning

confidence: 99%

The reversed halo sign: update and differential diagnosis

Godoy¹,

Viswanathan²,

Marchiori³

et al. 2012

BJR

Self Cite

136

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“…However, subsequent studies with pathologic confirmation have shown that the RHS is caused in most cases by the presence of non-necrotizing granulomas [11,28]. Two initial case reports described the RHS in patients with tuberculosis [29,30]; both had anatomopathologic confirmation showing multiple caseating granulomas and positive cultures for Mycobacterium tuberculosis. Recently, a study comparing 12 cases of the RHS in patients with tuberculosis and 10 in patients with COP [31] showed that all patients with tuberculosis presented the RHS with nodular walls and that small nodules were also observed inside the ground-glass component of the RHS in 83 % of these cases.…”

Section: Organizing Pneumoniamentioning

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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“…Questo segno è molto suggestivo di polmonite in organizzazione (PO) ed ha elevata specificità per questa diagnosi, anche se è stato rilevato solo in un quinto dei pazienti con tale patologia [32][33][34][35]. Altre malattie polmonari possono essere associate a componenti significative di PO e il RHS è stato recentemente descritto in altre condizioni, quali zigomicosi polmonare [36,37], la vasculite dei piccoli vasi polmonari [38], la granulomatosi di Wegener [39], la granulomatosi linfomatoide [40], la sarcoidosi [41,42], la tubercolosi polmonare [43,44]. Considerando il numero di pazienti esaminati, questo segno sembra essere rilevante nella polmonite da influenza A (H1N1).…”

Section: Fig 7abunclassified

H1N1 pneumonia: our experience in 50 patients with a severe clinical course of novel swine-origin influenza A (H1N1) virus (S-OIV)

et al. 2011

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The most common CXR and CT findings in patients with S-OIV infection were unilateral or bilateral ground-glass opacities with or without associated focal or multifocal areas of consolidation. On MDCT, ground-glass opacities and areas of consolidation had a predominant peribronchovascular and subpleural distribution, resembling organising pneumonia; they progressed to bilateral extensive airspace disease in severely ill patients.

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Pulmonary tuberculosis associated with the reversed halo sign on high-resolution CT

Cited by 38 publications

References 13 publications

The reversed halo sign: update and differential diagnosis

The reversed halo sign: update and differential diagnosis

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

H1N1 pneumonia: our experience in 50 patients with a severe clinical course of novel swine-origin influenza A (H1N1) virus (S-OIV)

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