The reversed halo sign: Considerations in the context of the COVID-19 pandemic

Marchiori, Edson; Nobre, Luiz Felipe; Hochhegger, Bruno; Zanetti, Gláucia

doi:10.1016/j.thromres.2020.08.001

Cited by 9 publications

(7 citation statements)

References 17 publications

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“…On the contrary, diagnosis of pulmonary CAM in general is challenging due to non‐specific symptoms and radiological findings, particularly in patients with pneumonia and critically ill patients. The reverse‐halo sign shown in the chest CT, which may be suggestive of pulmonary mucormycosis, has also been seen in patients with COVID‐19 pneumonia unrelated to mucormycosis 25 . In critically ill patients, invasive diagnostic procedures may be contraindicated further reducing diagnostic options in those patients to a minimum.…”

Section: Discussionmentioning

confidence: 99%

Results from a national survey on COVID‐19‐associated mucormycosis in Germany: 13 patients from six tertiary hospitals

Seidel

Simon

Sprute

et al. 2021

Mycoses

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Background Most COVID‐19‐associated mucormycosis (CAM) cases are reported from India and neighbouring countries. Anecdotally cases from Europe have been presented. Objective To estimate the disease burden and describe the clinical presentation of CAM in Germany. Methods We identified cases through German mycology networks and scientific societies, and collected anonymised clinical information via FungiScope®. Results We identified 13 CAM cases from six tertiary referral hospitals diagnosed between March 2020 and June 2021. Twelve patients had severe or critical COVID‐19, eleven were mechanically ventilated for a median of 8 days (range 1‐27 days) before diagnosis of CAM. Eleven patients received systemic corticosteroids. Additional underlying medical conditions were reported for all but one patient, five were immunocompromised because of malignancy or organ transplantation, three were diabetic. Eleven patients developed pneumonia. Mortality was 53.8% with a median time from diagnosis of mucormycosis to death of 9 days (range 0–214 days) despite treatment with liposomal amphotericin B and/or isavuconazole in 10 of 13 cases. CAM prevalence amongst hospitalised COVID‐19 patients overall (0.67% and 0.58% in two centres) and those admitted to the intensive care unit (ICU) (1.47%, 1.78% and 0.15% in three centres) was significantly higher compared to non‐COVID‐19 patients (P < .001 for respective comparisons). Conclusion COVID‐19‐associated mucormycosis is rare in Germany, mostly reported in patients with comorbidities and impaired immune system and severe COVID‐19 treated in the ICU with high mortality compared to mainly rhino‐orbito‐cerebral CAM in patients with mild COVID‐19 in India. Risk for CAM is higher in hospitalised COVID‐19 patients than in other patients.

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Section: Discussionmentioning

confidence: 99%

Results from a national survey on COVID‐19‐associated mucormycosis in Germany: 13 patients from six tertiary hospitals

Seidel

Simon

Sprute

et al. 2021

Mycoses

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“…In the reverse halo sign, also referred to as the Atoll sign, a dense crescentic shape of partial or near complete high-density ringlike consolidations surround central focal, round, or half-moon shaped areas of ground glass opacity (10,(13)(14)(15)(16)(17). In this case, the central ground glass opacity represents alveolar septal inflammation and cellular debris in the alveolar, while the ring-like surrounding consolidation represents granulomatous tissue within the distal air spaces.…”

Section: Halo and Reverse Halo Signmentioning

confidence: 99%

“…Thus, this radiographic finding represents a type of lung injury formed because of an organizing process that occurs in response to inflammatory pneumonitis or a pulmonary infarction (18). If the clinical suspicion for the later remains high, particularly in the presence of elevated D-dimer or sudden deterioration, CT angiography should be performed (15). The early versus later appearance of this sign depends on the underlying pathophysiologic process because it is typically absent in cases of organizing pneumonitis near the time of the onset of initial symptoms (17,19).…”

Section: Halo and Reverse Halo Signmentioning

confidence: 99%

Clarifying Terminology of Signs in COVID-19

Yale¹

2021

Erciyes Med J

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The term "sign" has been used to describe various phenomena observed in patients with coronavirus disease 2019 (COVID-19). Discrepancies in the use of this term have been identified when it is used in context with COVID-19. The goals of this review are to provide an overview, describe signs, and clarify misconceptions regarding the use of these terms in COVID-19 patients. PubMed and Medline databases were searched using individual and Medical Subject Headings (MeSH) terms, including coronavirus, COVID-19, and sign, in human studies within the English literature published from inception to December 31, 2020. Studies where the word "sign" was used in a context different from that for COVID-19 (e.g., sentinel sign) were excluded. Three hundred fifty-seven studies were potentially identified and after applying the exclusion criteria and further adjudication, 92 studies constituted the final data set. The majority of signs found in the COVID-19 literature have been applied and aptly described primarily in radiologic diseases of the chest. The term "sign," in other situations, is often misappropriated as it actually represents a physical finding rather than a sign. A total of 27 radiologic signs have been identified on chest computed tomography (CT) or high-resolution CT (HRCT), and 18 cutaneous signs (or findings) have been observed during the physical examination in COVID-19. Signs lack sufficient sensitivity or specificity by themselves; however, in the appropriate clinical setting, they should raise clinical suspicion for this infectious disease.

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“…The halo sign and RHS are nonspecific tomographic signs that have been described in patients with several infectious and noninfectious diseases [ 2 ], and were recently reported in patients with COVID-19 pneumonia [ 3 4 ]. A recent study [ 3 ] showed that the RHS may present two different morphological appearances in patients with COVID-19 infection: the traditional RHS, defined as a focal rounded area of ground-glass opacity surrounded by a more or less complete ring of consolidation [ 4 5 ], and the reticular RHS, characterized by low attenuation areas inside the halo, with or without reticulation, suggestive of pulmonary infarction [ 6 ].…”

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confidence: 99%