Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction

Marchiori, Edson; Barreto, Míriam Menna; Freitas, Heloisa Maria Pereira; Hochhegger, Bruno; Souza, Arthur Soares; Zanetti, Gláucia; Mançano, Alexandre Dias; Rodrigues, Rosana Souza

doi:10.1016/j.crad.2017.11.022

Cited by 19 publications

(19 citation statements)

References 23 publications

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“…With regard to the reticular RHS, the primary diagnostic hypothesis in immunocompromised patients is that of invasive fungal diseases 28 . In immunocompetent patients, the reticular RHS usually corresponds to PI, usually secondary to thromboembolic disease 29 …”

Section: Discussionmentioning

confidence: 99%

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

et al. 2019

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Objective: To determine the incidence of the reversed halo sign (RHS) in patients with pulmonary infarction (PI) due to acute pulmonary embolism (PE), detected by computed tomography angiography (CTA) of the pulmonary arteries, and to describe the main morphological features of the RHS. Methods: We evaluated 993 CTA scans, stratified by the risk of PE, performed between January of 2010 and December of 2014. Although PE was detected in 164 scans (16.5%), three of those scans were excluded because of respiratory motion artifacts. Of the remaining 161 scans, 75 (46.6%) showed lesions consistent with PI, totaling 86 lesions. Among those lesions, the RHS was seen in 33 (38.4%, in 29 patients). Results: Among the 29 patients with scans showing lesions characteristic of PI with the RHS, 25 (86.2%) had a single lesion and 4 (13.8%) had two, totaling 33 lesions. In all cases, the RHS was in a subpleural location. To standardize the analysis, all images were interpreted in the axial plane. Among those 33 lesions, the RHS was in the right lower lobe in 17 (51.5%), in the left lower lobe in 10 (30.3%), in the lingula in 5 (15.2%), and in the right upper lobe in 1 (3.0%). Among those same 33 lesions, areas of low attenuation were seen in 29 (87.9%). The RHS was oval in 24 (72.7%) of the cases and round in 9 (27.3%). Pleural effusion was seen in 21 (72.4%) of the 29 patients with PI and the RHS. Conclusions: A diagnosis of PE should be considered when there are findings such as those described here, even in patients with nonspecific clinical symptoms.

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Section: Discussionmentioning

confidence: 99%

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

et al. 2019

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“…La mayoría de los casos de infarto pul monar descritos en la literatura han presentado lesiones únicas. En otros casos se han observado dos infartos en algunos pacientes y la presencia de tres o más infartos es rara [5,6]. Las características tomográficas del signo de halo invertido son áreas de baja atenuación dentro del halo, con o sin reticulación y lucencias centrales [6,7] (Ver figura 8).…”

Section: Causa Vascularunclassified

El Signo De Halo Invertido En Tomografía Computada De Tórax [The Inverted Halo Sign in Thoracic Computed Tomography]

Reyna

Souza

2020

Rev Med Panama

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ResumenEl signo del halo invertido se caracteriza por una opacidad central de vidrio esmerilado rodeado por una consolidación del espacio aéreo más densa en forma de una media luna o un anillo. El signo del halo invertido se ha informado en asociación con un amplia gama de enfermedades pulmonares, incluidas las infecciones fúngicas pulmonares invasivas, neumonía por pneumocystis, tuberculosis, neumonía adquirida en la comunidad, granulomatosis linfomatoide, granulomatosis de Wegener, neumonía lipoidea y sarcoidosis. También se observa en neoplasmas pulmonares e infarto y después de radioterapia y ablación por radiofrecuencia de neoplasias malignas pulmonares. También es conocido como signo de halo en reversa o signo del atolón.AbstractThe reversed halo sign is characterized by a central ground-glass opacity surrounded by denser air–space consolidation in the shape of a crescent or a ring. The reversed halo sign has been reported in association with a wide range of pulmonary diseases, including invasive pulmonary fungal infections, 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. It is also known as a reverse halo sign or atoll sign.

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“…11 The mean time to cavitation for an infected pulmonary infarction has been reported to be 18 days. 12 A reversed halo sign, generally described as a focal, rounded area of ground-glass opacity surrounded by a nearly complete ring of consolidation, has been reported to be more frequent with pulmonary infarction than with other diseases, especially when in the lower lobes. 13…”

Section: ■ How Does Pulmonary Infarction Present Clinically?mentioning

confidence: 99%

Pulmonary infarction due to pulmonary embolism

Sonmez

Aboussouan

Farver

et al. 2018

CCJM

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A 76-year-old man whose history included abdominal aortic aneurysm repair, bilateral femoral artery bypass for popliteal artery aneurysm, hypertension, and peptic ulcer disease was admitted to a community hospital with pleuritic chest pain and shortness of breath. Two days earlier, he had undergone repair of a ventral hernia.At the time of that admission, he reported no fever, chills, night sweats, cough, or history of heart or lung disease. His vital signs were normal, and physical examination had revealed no apparent respiratory distress, no jugular venous distention, normal heart sounds, and no pedal edema; however, decreased air entry was noted in the right lung base. Initial serum levels of troponin and Nterminal pro-B-type natriuretic peptide were normal.At that time, computed tomographic angiography of the chest showed segmental pulmonary emboli in the left upper and right lower lobes of the lungs and right pleural effusion. Transthoracic echocardiography showed normal atrial and ventricular sizes with no right or left ventricular systolic dysfunction and a left ventricular ejection fraction of 59%.Treatment with intravenous heparin was started, and the patient was transferred to our hospital. ■ PLEURAL EFFUSION AND PULMONARY EMBOLISM1 Which of the following is true about pleural effusion? □ It is rarely, if ever, associated with pulmonary embolism □ Most patients with pleural effusion due to pulmonary embolism do not have pleuritic chest pain □ Pulmonary embolism should be excluded in all cases of pleural effusion without a clear cause Pulmonary embolism should be excluded in all cases of pleural effusion that do not have a clear cause. As for the other answer choices: • Pulmonary embolism is the fourth leading cause of pleural effusion in the United States, after heart failure, pneumonia, and malignancy. 1 • About 75% of patients who develop pleural effusion in the setting of pulmonary embolism complain of pleuritic chest pain on the side of the effusion. 2 Most effusions are unilateral, small, and usually exudative. 3 ■ EVALUATION BEGINS: RESULTS OF THORACENTESISOur patient continued to receive intravenous heparin. He underwent thoracentesis on hospital day 3, and 1,000 mL of turbid sanguineous pleural fl uid was removed. Analysis of the fl uid showed pH 7.27, white blood cell count 3.797 × 10 9 /L with 80% neutrophils, and lactate dehydrogenase (LDH) concentration 736 U/L (a ratio of pleural fl uid LDH to a concurrent serum LDH > 0.6 is suggestive of an exudate); the fl uid was also sent for culture and cytology. Thoracentesis was terminated early due to cough, and follow-

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Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction

Cited by 19 publications

References 23 publications

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries

El Signo De Halo Invertido En Tomografía Computada De Tórax [The Inverted Halo Sign in Thoracic Computed Tomography]

Pulmonary infarction due to pulmonary embolism

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