“Reversed Halo Sign” of High-resolution Computed Tomography in Pulmonary Sarcoidosis

Kumazoe, Hiroyuki; Matsunaga, Kazuko; Nagata, Nobuhiko; Komori, Motofumi; Wakamatsu, Kentarou; Kajiki, Akira; Nakazono, Takahiko; Kudo, Sho

doi:10.1097/rti.0b013e318190476f

Cited by 46 publications

(25 citation statements)

References 13 publications

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“…The RHS is an atypical manifestation of the disease that has been reported in a few patients ( Figure 6) [29][30][31]. As reported in granulomatous infections, Kumazoe et al [30] described the presence of small nodules within the ground-glass area and around the outer areas of consolidation of the RHS in a patient with sarcoidosis. Associated CT findings included a large nodule in the left upper lobe, small subpleural nodules along the costal pleural surface and fissures, and mediastinal lymphadenopathy.…”

Section: Sarcoidosismentioning

confidence: 88%

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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Section: Sarcoidosismentioning

confidence: 88%

The reversed halo sign: update and differential diagnosis

Godoy¹,

Viswanathan²,

Marchiori³

et al. 2012

BJR

139

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“…The authors also noted the presence of miliary nodules within the central ground-glass opacities and around the outer areas of consolidation [23,24]. Several other authors subsequently emphasized the need to include the RHS within the spectrum of HRCT findings of pulmonary sarcoidosis [25][26][27].…”

Section: Organizing Pneumoniamentioning

confidence: 92%

“…Later, Kumazoe et al [24] reported the RHS in a case of sarcoidosis in which high-resolution computed tomography (HRCT) images showed multiple, central ground-glass opacities surrounded by crescentic or ringshaped areas of consolidation in both lungs. The authors also noted the presence of miliary nodules within the central ground-glass opacities and around the outer areas of consolidation [23,24].…”

Section: Organizing Pneumoniamentioning

confidence: 97%

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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“…The sign was previously described by Voloudaki et al [2] and by Zompatori et al [3]. However, recently this sign has also been described in various diseases, including pulmonary paracoccidioidomycosis [4], pulmonary zygomycosis, invasive pulmonary aspergillosis [5], lymphomatoid granulomatosis [6], Wegener's granulomatosis [7], lipoid pneumonia [8], pulmonary sarcoidosis [9], drug-induced interstitial pneumonitis [10] and cellular NSIP [11]. In the reversed halo sign of paracoccidioidomycosis and lymphomatoid granulomatosis, the central area of ground-glass opacity consisted of an inflammatory infiltrate involving mainly the alveolar septa, and the peripheral consolidation consisted of dense and homogeneous intra-alveolar inflammatory infiltrates.…”

Section: Discussionmentioning

confidence: 77%

“…In lipoid pneumonia, chronic inflammation with granulomatous organising lesions may lead to the reversed halo sign [8]. In pulmonary sarcoidosis, the sign consists of non-caseating granuloma with no evidence of organising pneumonia [9]. In these several cases, we assume that the reversed halo sign is mainly attributable to various stages of inflammation.…”

Section: Discussionmentioning

confidence: 99%

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

Hong¹,

Kang²,

Shin³

et al. 2011

BJR

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ABSTRACT. We present a case of non-specific interstitial pneumonia (NSIP) with reversed halo sign on thin-section CT. A 52-year-old female presented with a cough and New York Heart Association (NYHA) class 2 dyspnoea of 4 months duration. A chest radiograph showed poorly defined, patchy ground-glass opacities in both lungs. Thinsection CT demonstrated the reversed halo sign, which is a central ground-glass opacity surrounded by crescent or ring-shaped areas of consolidation in multifocal areas. Multifocal patchy ground-glass opacity and consolidation and enlarged paratracheal, hilar and subcarinal lymph nodes were also shown. Video-assisted thoracic surgical (VATS) lung biopsy was performed, and histopathology revealed cellular NSIP.

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“Reversed Halo Sign” of High-resolution Computed Tomography in Pulmonary Sarcoidosis

Cited by 46 publications

References 13 publications

The reversed halo sign: update and differential diagnosis

The reversed halo sign: update and differential diagnosis

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

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

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