Reversed Halo Sign in Invasive Pulmonary Fungal Infections

Wahba, Hisham; Truong, Mylene T.; Lei, Xiudong; Kontoyiannis, Dimitrios P.; Marom, Edith M.

doi:10.1086/587991

Cited by 177 publications

(119 citation statements)

References 16 publications

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“…However, in invasive fungal infections, the RHS is due to infarct, with greater hemorrhage at the periphery than in the center. 20 The central infarct may show multiple levels of pulmonary arteries and veins extensively occluded by thrombi containing numerous Zygomycetes hyphae. In the peripheral ring, inflammation, massive hemorrhage, and fibrinous exudates were noted.…”

Section: Histopathologic Correlation Of the Rhsmentioning

confidence: 99%

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: Histopathologic Correlation Of the Rhsmentioning

confidence: 99%

Reversed Halo Sign: A Systematic Review

Maturu

Agarwal

2014

Respir Care

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“…The sign was previously described by Voloudaki et al [2] and by Zompatori et al [3]. However, recently this sign has also been described in various diseases, including pulmonary paracoccidioidomycosis [4], pulmonary zygomycosis, invasive pulmonary aspergillosis [5], lymphomatoid granulomatosis [6], Wegener's granulomatosis [7], lipoid pneumonia [8], pulmonary sarcoidosis [9], drug-induced interstitial pneumonitis [10] and cellular NSIP [11]. In the reversed halo sign of paracoccidioidomycosis and lymphomatoid granulomatosis, the central area of ground-glass opacity consisted of an inflammatory infiltrate involving mainly the alveolar septa, and the peripheral consolidation consisted of dense and homogeneous intra-alveolar inflammatory infiltrates.…”

Section: Discussionmentioning

confidence: 80%

“…There was no evidence of organising pneumonia [4,6]. In pulmonary zygomycosis and invasive pulmonary aspergillosis, the reversed halo sign was attributable to an infarcted lung with a greater amount of haemorrhage in the peripheral consolidation than in the central groundglass opacity [5]. In lipoid pneumonia, chronic inflammation with granulomatous organising lesions may lead to the reversed halo sign [8].…”

Section: Discussionmentioning

confidence: 99%

Reversed halo sign on thin-section CT in a patient with non-specific interstitial pneumonia

Hong¹,

Kang²,

Shin³

et al. 2011

BJR

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ABSTRACT. We present a case of non-specific interstitial pneumonia (NSIP) with reversed halo sign on thin-section CT. A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration. A chest radiograph showed poorly defined, patchy ground-glass opacities in both lungs. Thinsection CT demonstrated the reversed halo sign, which is a central ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation in multifocal areas. Multifocal patchy ground-glass opacity and consolidation and enlarged paratracheal, hilar and subcarinal lymph nodes were also shown. Video-assisted thoracic surgical (VATS) lung biopsy was performed, and histopathology revealed cellular NSIP.

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“…Several authors have attempted to document the presence of multiple RHSs in a wide spectrum of diseases, such as cryptogenic OP (COP), tuberculosis, sarcoidosis, invasive fungal infections and granulomatosis with polyangiitis. 10,12,[17][18][19][20] Nevertheless, in a study comparing RHS characteristics in tuberculosis and COP, 18 solitary and multiple lesions were observed in both diseases. Indeed, although multiple RHSs were found in all patients with PCM in our study, this finding is not specific.…”

Section: Discussionmentioning

confidence: 93%

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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Reversed Halo Sign in Invasive Pulmonary Fungal Infections

Cited by 177 publications

References 16 publications

Reversed Halo Sign: A Systematic Review

Reversed Halo Sign: A Systematic Review

Reversed halo sign on thin-section CT in a patient with non-specific interstitial pneumonia

CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis

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