Reversed halo sign in acute pulmonary embolism and infarction

Casullo, Joseph; Semionov, Alexandre

doi:10.1177/0284185113475797

Cited by 21 publications

(26 citation statements)

References 9 publications

(13 reference statements)

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“…In fact, the presence of the RHS in an immunocompromised host should be attributed to invasive fungal infection unless proven otherwise. The RHS 16 1 Pulmonary thromboembolism 46,49 19 Pulmonary tumor embolus 52 1 Pulmonary edema 46 3 Bronchoalveolar carcinoma 46 3 Hypersensitivity pneumonitis 57 1 Tuberous sclerosis complex 56 1 Lymphocytic interstitial pneumonia 51 1 Total 209…”

Section: Discussionmentioning

confidence: 99%

“…Other noninfectious diseases associated with the RHS are sarcoidosis, vasculitis, and a cellular variant of nonspecific interstitial pneumonia. Another important condition associated with the RHS is pulmonary thromboembolism, 46,49 where the diagnosis would be based on clinicoradiologic grounds. There are also case reports of association with other diseases such as lipoid pneumonia, lymphomatoid granulomatosis, lymphocytic interstitial pneumonia, tuberous sclerosis complex, hypersensitivity pneumonia, and bronchoalveolar carcinoma.…”

Section: Noninfectious Diseasesmentioning

confidence: 99%

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Reversed Halo Sign: A Systematic Review

Maturu

Agarwal

2014

Respir Care

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A reversed halo sign (RHS) is defined as the presence of a focal ring-shaped area of ground-glass opacity within a peripheral rim of consolidation. Although originally described in patients with cryptogenic organizing pneumonia, it has been described with several other noninfectious and infectious diseases, including fungal infections. Thus, it is imperative that a proper diagnosis be established before initiating treatment. In this article, we systematically review the literature (PubMed and Embase) for the associations of the RHS. We have also proposed a diagnostic algorithm for an approach to a patient with an RHS.

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Section: Discussionmentioning

confidence: 99%

Section: Noninfectious Diseasesmentioning

confidence: 99%

Reversed Halo Sign: A Systematic Review

Maturu

Agarwal

2014

Respir Care

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“…10 Single RHSs have frequently been described in patients with diseases that cause pulmonary infarction; Marchiori et al 10 described single RHSs in all 6 patients with invasive pulmonary aspergillosis and Casullo and Semionov 13 observed them in 10 of 12 patients with PE. The majority of infectious and non-infectious diseases, however, presents with multiple RHSs.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of small nodules in the wall or inside the RHS lesion indicates active granulomatous disease, 6,10,11 and reticulation in the centre of the halo suggests diseases or conditions that cause pulmonary infarction, such as invasive pulmonary aspergillosis and pulmonary embolism (PE). 12,13 The recognition of specific characteristics of the RHS associated with pulmonary PCM has important clinical implications that may enable the early institution of treatment.…”

Section: Introductionmentioning

confidence: 99%

CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis

Barreto

Marchiori

Brito³

et al. 2015

BJR

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Objective: The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest CT in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease. Methods: We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analysed the morphological characteristics of the lesions and reached decisions by consensus. Results: We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 17 patients (73.9% of cases). 34 (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%) lesions and irregular/spiculated in 16 (25%) lesions. Groundglass opacity was observed inside 63 (98.4%) lesions. Conclusion: Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas. Advances in knowledge: This is the largest series of patients with RHS due to PCM and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphological characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease.

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“…Este último posee baja sensibilidad siendo observado entre 11,5% y 27% y se ha descrito en otras patologías 29,32,33 . El hallazgo del halo reverso no fue visto en este paciente, considerado de mayor especificidad [34][35][36][37] .…”

Section: Neumonía Criptogénica Organizadaunclassified

Neumonía criptogénica organizada como diagnóstico diferencial de neumonía que no responde a tratamiento: Report of one case

Charpentier

et al. 2014

Rev. méd. Chile

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Non-resolving pneumonia is a common clinical problem that prolongs morbidity and increases hospitalization costs. We report an 82 year-old non-smoking female who was admitted with chronic diarrhea and later developed nosocomial pneumonia. Lung infiltrates did nota neumonía que no responde a tratamiento (NNRT) es un problema relativamente frecuente entre pacientes hospitalizados que aumenta la morbimortalidad y cuya incidencia oscila entre 13 y 18% 1-3 . El estudio y manejo de estos pacientes comúnmente se fundamenta en la experiencia clínica, más que en evidencia cientí-fica. Un enfrentamiento inadecuado puede llevar a intervenciones innecesarias, aumentando los costos, estadía hospitalaria y las complicaciones.Una de las causas de la NNRT es la neumonía organizada, una entidad poco conocida, subdiagnosticada y que puede ser secundaria a múltiples causas, siendo de diagnóstico fundamentalmente histopatológico 4 . Cuando no se logra identificar una etiología se denomina neumonía organizada criptogénica (Cryptogenic Organizing Pneumonia: COP). Su potencial respuesta a corticoides, hace de esta patología un desafío para el clínico, especialmente cuando se han agotado los recursos diagnósticos y estrategias terapéuticas convencionales.Este artículo tiene como propósito dar a conocer un caso de COP que se presentó como

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Reversed halo sign in acute pulmonary embolism and infarction

Abstract: The reversed halo sign very likely corresponds to pulmonary infarction in patients with acute PE. Its recognition may have important clinical implications.

Cited by 21 publications

References 9 publications

Reversed Halo Sign: A Systematic Review

Reversed Halo Sign: A Systematic Review

CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis

Neumonía criptogénica organizada como diagnóstico diferencial de neumonía que no responde a tratamiento: Report of one case

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