Reversed halo sign in pneumocystis pneumonia: a case report

Otera, Hiroshi; Tada, Kimihide; Sakurai, Toshiyasu; Hashimoto, Kimio; Ikeda, Akihiko

doi:10.1186/1471-2342-10-26

Cited by 15 publications

(5 citation statements)

References 20 publications

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“…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 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: 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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“…This finding was first described in patients with cryptogenic organizing pneumonia and was considered pathognomonic for this disease, until it was also described in other diseases such as PCM, tuberculosis, mucormycosis, invasive pulmonary aspergillosis, Pneumocystis jirovecii, organizing pneumonia, granulomatous polyangiitis, lymphomatoid granulomatosis, sarcoidosis, and lepidic predominant adenocarcinoma, among others. 95,[103][104][105][106][107][108][109][110][111][112][113][114][115] The halo sign is another CT pattern that can be visualized in a large variety of pulmonary diseases and is, therefore, nonspecific. However, it is generally connected to hemorrhagical nodules.…”

Section: Computed Tomographymentioning

confidence: 99%

New Insights on Pulmonary Paracoccidioidomycosis

Queiroz-Telles

Peçanha-Pietrobom

Júnior

et al. 2020

Semin Respir Crit Care Med

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Paracoccidioidomycosis (PCM) is one of the most relevant systemic endemic mycoses in Latin American countries, especially in South American countries, with endemic and hyperendemic areas. The real burden of PCM may be underestimated because of a lack of compulsory case notification. Recent phylogenetic data revealed that Paracoccidioides brasiliensis comprises several cryptic species including P. brasiliensis and P. lutzii. However, the genetic biodiversity of Paracoccidioides does not affect the clinical manifestations or therapeutic response to therapy. Lung involvement is a common finding, especially in patients experiencing the chronic form of the disease, and, because of its similarities with tuberculosis, clinicians must be alert to the possibility of PCM in patients with chronic respiratory manifestations and epidemiological risk factors for this fungal disease.

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“…A tissue diagnosis can be obtained in patients with atypical clinico-radiological features to ensure appropriate treatment. [4] In our patient, a biopsy was performed in view of the younger age and absence of features to suggest a connective tissue disorder. In a female patient with known connective tissue disorder, if classical radiological features suggestive of COP are present, a biopsy is usually not required.…”

Section: Answermentioning

confidence: 99%