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

Hong, Sansikk; Kang, Eun Young; Shin, Bong Kyung; Shim, Jae Jeong

doi:10.1259/bjr/43867123

Cited by 6 publications

(3 citation statements)

References 11 publications

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“…Although several publications have attributed the RHS directly to different diseases (dermatomyositis [18], lipoid pneumonia [19], radiotherapy [17], nonspecific interstitial pneumonia [20]), descriptions of the pathologic findings in these cases show evidence of secondary OP (e.g., presence of polypoid granulation tissue).Thus, the RHS most likely represented secondary OP as a response to the primary disease in these cases. In other cases, such as in one patient with pneumococcal pneumonia [21], the RHS appeared during the resolution phase of the disease, days or weeks after the diagnosis of pulmonary infection had been made.…”

Section: Organizing Pneumoniamentioning

confidence: 95%

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: Organizing Pneumoniamentioning

confidence: 95%

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

Marchiori

Zanetti

Hochhegger

et al. 2012

Lung

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“…The spectrum of the disease ranges from predominant interstitial inflammation (cellular NSIP) to predominant fibrosis (fibrotic NSIP), the latter having a worse prognosis [24,25]. The RHS has been sporadically reported in cases of cellular NSIP [26,27].…”

Section: Non-specific Interstitial Pneumoniamentioning

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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“…[13] Therefore, interpretation of this radiological sign must be done in conjunction with the clinical profile. A tissue diagnosis can be obtained in patients with atypical clinico-radiological features to ensure appropriate treatment.…”

Section: Answermentioning

confidence: 99%