Pulmonary Histoplasmosis Presenting With the Reversed Halo Sign on High-Resolution CT Scan

Marchiori, Edson; Melo, Saulo Maia D'Ávila; Vianna, Flávia Gavinho; Melo, Bárbara Santana D'Avila; Melo, Saulo Santana D.; Zanetti, Gláucia

doi:10.1378/chest.11-0055

Cited by 14 publications

(9 citation statements)

References 24 publications

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“…However, in 2005, Gasparetto et al [8] reported that they had observed the RHS in 15 patients with paracoccidioidomycosis, which indicated that the RHS could be seen in patients with active infection and was therefore not specific for COP. Subsequently, various authors have demonstrated the presence of this sign in a wide spectrum of diseases, including infectious and noninfectious pulmonary disorders, confirming the nonspecific nature of the RHS [9][10][11][12].…”

Section: Introductionmentioning

confidence: 79%

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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: Introductionmentioning

confidence: 79%

“…A few isolated cases of other noninvasive fungal infections presenting with the RHS have been described, including histoplasmosis [10] and Pneumocystis jiroveci pneumonia [39], the latter occurring in immunocompromised patients with acquired immune deficiency syndrome (AIDS).…”

Section: Paracoccidioidomycosis and Other Noninvasive Fungal Infectionsmentioning

confidence: 99%

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

Marchiori

Zanetti

Hochhegger

et al. 2012

Lung

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“…The RHS has also been sporadically reported in patients with histoplasmosis and cryptococcosis [11,12].…”

Section: Endemic Fungal Infectionsmentioning

confidence: 91%

The reversed halo sign: update and differential diagnosis

Godoy¹,

Viswanathan²,

Marchiori³

et al. 2012

BJR

139

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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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“…In invasive fungal infection complicating immunosuppressed individuals, the sign appears as one or more large lesions, whereas in endemic mycoses, the lesions are bilateral and asymmetric, associated with ground-glass opacities, centrilobular nodules, or areas of consolidation. 8,41 Other infections where it is uncommonly seen are histoplasmosis, cryptococcosis, influenza, psittacosis, Pneumocystis, and Legionella pneumonia. In patients with pneumococcal pneumonia, the RHS has been seen in the resolution phase and thus represents a post-infectious organizing pneumonia.…”

Section: Infectious Diseasesmentioning

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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Pulmonary Histoplasmosis Presenting With the Reversed Halo Sign on High-Resolution CT Scan

Cited by 14 publications

References 24 publications

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

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

The reversed halo sign: update and differential diagnosis

Reversed Halo Sign: A Systematic Review

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