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Edson Marchiori - One of the best experts on this subject based on the ideXlab platform.
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Frequency and Reliability of the Reversed Halo Sign in Patients With Septic Pulmonary Embolism Due to IV Substance Use Disorder
AJR. American journal of roentgenology, 2019Co-Authors: Renata R. Almeida, Edson Marchiori, Efren J. FloresAbstract:OBJECTIVE. The purpose of this article is to assess the "reversed Halo" Sign in patients with septic pulmonary embolism (PE) due to IV substance use disorder. MATERIALS AND METHODS. A retrospective analysis was performed of chest CT scans obtained between 2007 and 2017 that had findings of septic PE associated with IV substance use disorder. Inclusion criteria were history of IV substance use disorder, findings of septic PE on chest CT scans, and confirmation of infection. Image analysis was performed by three radiologists to assess the frequency, appearance, and evolution of the reversed Halo Sign. Interreader agreement to characterize the reversed Halo Sign was assessed using kappa statistical analysis. The chi-square test was used to correlate reversed Halo Sign shape with evolution on follow-up scans. RESULTS. Of 62 patients who met the inclusion criteria (54.8% women; mean age, 32.8 ± 8.3 [SD] years), 59.7% (37/62) had reversed Halo Signs (κ = 0.837-0.958, p < 0.0001). The mean number of unique reversed Halo Signs per patient was 2.1 ± 1.7 (46.7% of patients had more than one reversed Halo Sign). Of 78 unique reversed Halo Signs, 93.6% (73/78) were peripherally located and 51.3% (40/78) were located at the lower lobe, 52.6% (41/78) were pyramidal and 47.4% (37/78) were round shaped, 89.7% (70/78) had central low-attenuation areas, and 34.6% (27/78) had internal reticulations. Cavitation developed in 37.2% (29/78) of reversed Halo Signs and more often in pyramid-shaped ones (70.8%, 17/24), whereas consolidation occurred in 30.8% (24/78) and more often in round-shaped ones (58.6%; 17/29, p = 0.03). CONCLUSION. Septic PE should be considered in the differential diagnosis of patients with IV substance use disorder presenting with reversed Halo Sign. The reversed Halo Sign was reliably and frequently observed on the chest CT scans of patients with IV substance use disorder-related septic PE. Characteristics of reversed Halo Sign presentation were identified as potential features to differentiate septic PE from other causes of pulmonary infarct manifesting with reversed Halo Sign.
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The Halo Sign: HRCT findings in 85 patients.
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2016Co-Authors: Giordano Rafael Tronco Alves, Klaus L. Irion, Edson Marchiori, Carlos Schuler Nin, Guilherme Watte, Alessandro C. Pasqualotto, Luiz Carlos Severo, Bruno HochheggerAbstract:Objective: The Halo Sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of Halo Sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with Halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the Halo Sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker Halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the Halo Sign. Objetivo: O sinal do Halo consiste em uma area de opacidade em vidro fosco ao redor de lesoes pulmonares em imagens de TC de torax. Pacientes imunocompetentes e imunodeprimidos foram comparados quanto a caracteristicas do sinal do Halo a fim de identificar as de maior valor diagnostico. Metodos: Estudo retrospectivo de tomografias realizadas em sete centros entre janeiro de 2011 e maio de 2015. Os pacientes foram classificados de acordo com seu estado imunologico. Dois radiologistas toracicos analisaram os exames a fim de determinar o numero de lesoes e sua distribuicao, tamanho e contorno, bem como a espessura do Halo e quaisquer outros achados associados. Resultados: Dos 85 pacientes avaliados, 53 eram imunocompetentes e 32 eram imunodeprimidos. Dos 53 pacientes imunocompetentes, 34 (64%) receberam diagnostico de neoplasia primaria. Dos 32 pacientes imunodeprimidos, 25 (78%) receberam diagnostico de aspergilose. Lesoes multiplas e distribuidas aleatoriamente foram mais comuns nos imunodeprimidos do que nos imunocompetentes (p < 0,001 para ambas). A espessura do Halo foi maior nos imunodeprimidos (p < 0,05). Conclusoes: As etiologias do sinal do Halo em pacientes imunocompetentes sao bastante diferentes das observadas em pacientes imunodeprimidos. Embora Halos mais espessos ocorram mais provavelmente em pacientes com doencas infecciosas, o numero e a distribuicao das lesoes tambem devem ser levados em conta na avaliacao de pacientes que apresentem o sinal do Halo.
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Reversed Halo Sign.
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2015Co-Authors: Edson Marchiori, Gláucia Zanetti, Bruno HochheggerAbstract:1. Universidade Federal Fluminense, Niteroi (RJ) Brasil. 2. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 3. Faculdade de Medicina de Petropolis, Petropolis (RJ) Brasil. 4. Santa Casa de Misericordia de Porto Alegre, Porto Alegre (RS) Brasil. 5. Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre (RS) Brasil. A 35-year-old man presented to the emergency room with chest pain accompanied by dyspnea. He reported having sustained a lower limb fracture and having been immobilized for 30 days. A CT scan showed the reversed Halo Sign (RHS) with a reticular pattern, and the final diagnosis was pulmonary infarction. The RHS found on HRCT of the chest is defined as a rounded area of ground-glass attenuation surrounded by a ring of consolidation. This Sign was initially described as a Sign specific for organizing pneumonia (OP). Later studies identified the RHS in a wide spectrum of infectious and noninfectious diseases. In Brazil, the most common infectious causes of the RHS are tuberculosis, paracoccidioidomycosis, and invasive fungal diseases (invasive pulmonary aspergillosis and mucormycosis). Among the noninfectious causes, OP, both idiopathic and secondary, is the most common. Other important causes are pulmonary infarction and sarcoidosis. Although the RHS is considered a nonspecific Sign, a careful analysis of its morphological characteristics can narrow the differential diagnosis, helping the attending physician to make a definitive diagnosis. Two imaging patterns should be taken into account in order to make the diagnosis more specific: the presence of nodules on the wall of or within the Halo (nodular RHS); and a reticular pattern within the Halo (reticular RHS).
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Pulmonary histoplasmosis presenting with a Halo Sign on CT in an immunocompetent patient.
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2013Co-Authors: Graziella Hanna Pereira, Liliane Yuri Almeida, Rosa Shizuda Okubo, Edson MarchioriAbstract:Histoplasmosis is a common endemic mycosis. Although most infections in immunocompetent individuals are self-limiting, some patients develop severe pneumonitis or other types of chronic pulmonary infection. Specific imaging findings depend on the organisms involved, the underlying condition of the patient, and his condition after immune depleting procedures. The disease process in immunocompetent patients is usually limited to a solitary nodule on chest X-rays or CT scans, but enlarged hilar or mediastinal lymph nodes can also be observed.(1) We report here the case of an immunocompetent patient with histoplasmosis who presented with a Halo Sign on CT. A 47-year-old man presented with dry cough, chest pain, fatigue, and fever, having started 15 days prior. He reported neither comorbidities nor a contact with environments with mold. The patient was negative for HIV by ELISA. Laboratory tests revealed leukocytosis, elevated C-reactive protein levels (33 mg/L), and hypertransaminasemia (three-fold higher than the upper limit of normal). CT scanning revealed a pulmonary nodule with a Halo Sign in his left lower lobe (Figure 1) and left para-hilar lymph nodes. Histological examination of a pulmonary biopsy sample obtained during bronchoscopy showed nonspecific inflammatory alterations. Cultures for mycobacteria and fungi were negative. Serology by counterimmunoelectrophoresis was positive for histoplasmosis. Treatment was initiated with itraconazole (400 mg/day). After 30 days, a CT scan showed that the size of the nodule was reduced by half.
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The reversed Halo Sign: update and differential diagnosis
The British journal of radiology, 2012Co-Authors: Myrna C.b. Godoy, Edson Marchiori, Mylene T. Truong, Chitra Viswanathan, Marcelo F. Benveniste, Santiago E. Rossi, Edith M. MaromAbstract: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.
Gláucia Zanetti - One of the best experts on this subject based on the ideXlab platform.
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Reversed Halo Sign.
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2015Co-Authors: Edson Marchiori, Gláucia Zanetti, Bruno HochheggerAbstract:1. Universidade Federal Fluminense, Niteroi (RJ) Brasil. 2. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 3. Faculdade de Medicina de Petropolis, Petropolis (RJ) Brasil. 4. Santa Casa de Misericordia de Porto Alegre, Porto Alegre (RS) Brasil. 5. Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre (RS) Brasil. A 35-year-old man presented to the emergency room with chest pain accompanied by dyspnea. He reported having sustained a lower limb fracture and having been immobilized for 30 days. A CT scan showed the reversed Halo Sign (RHS) with a reticular pattern, and the final diagnosis was pulmonary infarction. The RHS found on HRCT of the chest is defined as a rounded area of ground-glass attenuation surrounded by a ring of consolidation. This Sign was initially described as a Sign specific for organizing pneumonia (OP). Later studies identified the RHS in a wide spectrum of infectious and noninfectious diseases. In Brazil, the most common infectious causes of the RHS are tuberculosis, paracoccidioidomycosis, and invasive fungal diseases (invasive pulmonary aspergillosis and mucormycosis). Among the noninfectious causes, OP, both idiopathic and secondary, is the most common. Other important causes are pulmonary infarction and sarcoidosis. Although the RHS is considered a nonspecific Sign, a careful analysis of its morphological characteristics can narrow the differential diagnosis, helping the attending physician to make a definitive diagnosis. Two imaging patterns should be taken into account in order to make the diagnosis more specific: the presence of nodules on the wall of or within the Halo (nodular RHS); and a reticular pattern within the Halo (reticular RHS).
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Pulmonary histoplasmosis presenting with the reversed Halo Sign on high-resolution CT scan.
Chest, 2011Co-Authors: Edson Marchiori, Saulo Maia D'Ávila Melo, Flávia Gavinho Vianna, Bárbara Santana D´avila Melo, Saulo Santana D. Melo, Gláucia ZanettiAbstract:We describe the case of a 23-year-old man with pulmonary histoplasmosis whose high-resolution CT scan demonstrated the reversed Halo Sign. We also extensively review the literature about this CT scan Sign. The reversed Halo Sign has been described in a number of diseases, both infectious and noninfectious. However, to our knowledge, this is the first reported case of pulmonary histoplasmosis presenting with this radiologic finding.
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Reversed Halo Sign in active pulmonary tuberculosis: criteria for differentiation from cryptogenic organizing pneumonia.
AJR. American journal of roentgenology, 2011Co-Authors: Edson Marchiori, Klaus L. Irion, Bruno Hochhegger, Gláucia Zanetti, Luiz Felipe Nobre, Alexandre Dias Mançano, Dante Luiz EscuissatoAbstract:OBJECTIVE. The purpose of this study was to compare the morphologic characteristics of the “reversed Halo” Sign caused by tuberculosis with those caused by cryptogenic organizing pneumonia (COP) and to determine whether high-resolution CT (HRCT) can differentiate between these two conditions. MATERIALS AND METHODS. We retrospectively reviewed the HRCT scans of patients with the reversed Halo Sign caused by active tuberculosis and HRCT scans of patients with the reversed Halo Sign caused by COP. The study included 12 patients with active pulmonary tuberculosis (10 women and two men) and 10 patients with biopsy-proven COP (five women and five men). Tuberculosis was diagnosed by culture of sputum, bronchoalveolar lavage, or biopsy specimen. All patients underwent HRCT, and the images were reviewed by two chest radiologists who reached decisions by consensus. RESULTS. HRCT scans of all patients with active tuberculosis showed reversed Halos with nodular walls; in most cases (10/12), we also observed nodules i...
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The reversed Halo Sign on high-resolution CT in infectious and noninfectious pulmonary diseases.
AJR. American journal of roentgenology, 2011Co-Authors: Edson Marchiori, Gláucia Zanetti, Dante Luiz Escuissato, Gustavo De Souza Portes Meirelles, Arthur Soares Souza, Bruno HochheggerAbstract:OBJECTIVE. The purpose of this article is to describe diseases that may present with the reversed Halo Sign on high-resolution CT. We emphasize the tomographic features most frequently associated with this Sign and correlate them with histologic findings. CONCLUSION. A wide spectrum of infectious and noninfectious diseases may present with the reversed Halo Sign on chest CT. The nonspecific nature of this Sign should not cloud an otherwise fairly straightforward diagnosis, especially when associated background findings are typical. Although a rigorous analysis of associated CT findings may help with the differential diagnosis, histologic assessment is often needed for a definitive determination of the cause.
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Pulmonary tuberculosis associated with the reversed Halo Sign on high-resolution CT
The British journal of radiology, 2010Co-Authors: Edson Marchiori, Gláucia Zanetti, R D Grando, C E Simões Dos Santos, L Maffazzioli Santos Balzan, Claudia Mauro Mano, R S GutierrezAbstract:We describe the case of a 32-year-old woman with pulmonary tuberculosis in whom a high-resolution CT scan demonstrated the reversed Halo Sign. The diagnosis of tuberculosis was made by lung biopsy and the detection of acid-fast bacilli in the sputum smear and culture. Follow-up assessment revealed a Significant improvement in the lesions.
Myrna C.b. Godoy - One of the best experts on this subject based on the ideXlab platform.
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The reversed Halo Sign: update and differential diagnosis
The British journal of radiology, 2012Co-Authors: Myrna C.b. Godoy, Edson Marchiori, Mylene T. Truong, Chitra Viswanathan, Marcelo F. Benveniste, Santiago E. Rossi, Edith M. MaromAbstract: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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Reversed Halo Sign in pulmonary zygomycosis
Thorax, 2011Co-Authors: Myrna C.b. Godoy, Edith M. MaromAbstract:We read with interest the article ‘The atoll Sign’ by Walsh and Roberton1 in the November issue of Thorax . The authors report a case of cryptogenic organising pneumonia with the atoll Sign, also called the reversed Halo Sign. As mentioned by the authors, this CT Sign was first described in cryptogenic organising pneumonia and was initially considered to be specific for this disease.2 It was subsequently reported in …
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Reversed Halo Sign after radiofrequency ablation of a lung nodule.
Journal of thoracic imaging, 2011Co-Authors: Victoria L. Mango, David P. Naidich, Myrna C.b. GodoyAbstract:We report a case of the "reversed Halo Sign" 6 weeks after radiofrequency ablation (RFA) of a lung neoplasm in an 80-year-old man. The "reversed Halo Sign," first described on computed tomography in cryptogenic organizing pneumonia, has later been described as being associated with a wide range of pulmonary pathologies, including paracoccidiodomycosis, tuberculosis, lymphomatoid granulomatosis, Wegener granulomatosis, invasive pulmonary fungal infections, and sarcoidosis. Although a number of computed tomography findings have been reported after RFA of both primary lung tumors and pulmonary metastases, this case demonstrates that the reversed Halo Sign may also occur after RFA.
Bruno Hochhegger - One of the best experts on this subject based on the ideXlab platform.
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The Halo Sign: HRCT findings in 85 patients.
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2016Co-Authors: Giordano Rafael Tronco Alves, Klaus L. Irion, Edson Marchiori, Carlos Schuler Nin, Guilherme Watte, Alessandro C. Pasqualotto, Luiz Carlos Severo, Bruno HochheggerAbstract:Objective: The Halo Sign consists of an area of ground-glass opacity surrounding pulmonary lesions on chest CT scans. We compared immunocompetent and immunosuppressed patients in terms of Halo Sign features and sought to identify those of greatest diagnostic value. Methods: This was a retrospective study of CT scans performed at any of seven centers between January of 2011 and May of 2015. Patients were classified according to their immune status. Two thoracic radiologists reviewed the scans in order to determine the number of lesions, as well as their distribution, size, and contour, together with Halo thickness and any other associated findings. Results: Of the 85 patients evaluated, 53 were immunocompetent and 32 were immunosuppressed. Of the 53 immunocompetent patients, 34 (64%) were diagnosed with primary neoplasm. Of the 32 immunosuppressed patients, 25 (78%) were diagnosed with aspergillosis. Multiple and randomly distributed lesions were more common in the immunosuppressed patients than in the immunocompetent patients (p < 0.001 for both). Halo thickness was found to be greater in the immunosuppressed patients (p < 0.05). Conclusions: Etiologies of the Halo Sign differ markedly between immunocompetent and immunosuppressed patients. Although thicker Halos are more likely to occur in patients with infectious diseases, the number and distribution of lesions should also be taken into account when evaluating patients presenting with the Halo Sign. Objetivo: O sinal do Halo consiste em uma area de opacidade em vidro fosco ao redor de lesoes pulmonares em imagens de TC de torax. Pacientes imunocompetentes e imunodeprimidos foram comparados quanto a caracteristicas do sinal do Halo a fim de identificar as de maior valor diagnostico. Metodos: Estudo retrospectivo de tomografias realizadas em sete centros entre janeiro de 2011 e maio de 2015. Os pacientes foram classificados de acordo com seu estado imunologico. Dois radiologistas toracicos analisaram os exames a fim de determinar o numero de lesoes e sua distribuicao, tamanho e contorno, bem como a espessura do Halo e quaisquer outros achados associados. Resultados: Dos 85 pacientes avaliados, 53 eram imunocompetentes e 32 eram imunodeprimidos. Dos 53 pacientes imunocompetentes, 34 (64%) receberam diagnostico de neoplasia primaria. Dos 32 pacientes imunodeprimidos, 25 (78%) receberam diagnostico de aspergilose. Lesoes multiplas e distribuidas aleatoriamente foram mais comuns nos imunodeprimidos do que nos imunocompetentes (p < 0,001 para ambas). A espessura do Halo foi maior nos imunodeprimidos (p < 0,05). Conclusoes: As etiologias do sinal do Halo em pacientes imunocompetentes sao bastante diferentes das observadas em pacientes imunodeprimidos. Embora Halos mais espessos ocorram mais provavelmente em pacientes com doencas infecciosas, o numero e a distribuicao das lesoes tambem devem ser levados em conta na avaliacao de pacientes que apresentem o sinal do Halo.
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Reversed Halo Sign.
Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 2015Co-Authors: Edson Marchiori, Gláucia Zanetti, Bruno HochheggerAbstract:1. Universidade Federal Fluminense, Niteroi (RJ) Brasil. 2. Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 3. Faculdade de Medicina de Petropolis, Petropolis (RJ) Brasil. 4. Santa Casa de Misericordia de Porto Alegre, Porto Alegre (RS) Brasil. 5. Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre (RS) Brasil. A 35-year-old man presented to the emergency room with chest pain accompanied by dyspnea. He reported having sustained a lower limb fracture and having been immobilized for 30 days. A CT scan showed the reversed Halo Sign (RHS) with a reticular pattern, and the final diagnosis was pulmonary infarction. The RHS found on HRCT of the chest is defined as a rounded area of ground-glass attenuation surrounded by a ring of consolidation. This Sign was initially described as a Sign specific for organizing pneumonia (OP). Later studies identified the RHS in a wide spectrum of infectious and noninfectious diseases. In Brazil, the most common infectious causes of the RHS are tuberculosis, paracoccidioidomycosis, and invasive fungal diseases (invasive pulmonary aspergillosis and mucormycosis). Among the noninfectious causes, OP, both idiopathic and secondary, is the most common. Other important causes are pulmonary infarction and sarcoidosis. Although the RHS is considered a nonspecific Sign, a careful analysis of its morphological characteristics can narrow the differential diagnosis, helping the attending physician to make a definitive diagnosis. Two imaging patterns should be taken into account in order to make the diagnosis more specific: the presence of nodules on the wall of or within the Halo (nodular RHS); and a reticular pattern within the Halo (reticular RHS).
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Reversed Halo Sign in active pulmonary tuberculosis: criteria for differentiation from cryptogenic organizing pneumonia.
AJR. American journal of roentgenology, 2011Co-Authors: Edson Marchiori, Klaus L. Irion, Bruno Hochhegger, Gláucia Zanetti, Luiz Felipe Nobre, Alexandre Dias Mançano, Dante Luiz EscuissatoAbstract:OBJECTIVE. The purpose of this study was to compare the morphologic characteristics of the “reversed Halo” Sign caused by tuberculosis with those caused by cryptogenic organizing pneumonia (COP) and to determine whether high-resolution CT (HRCT) can differentiate between these two conditions. MATERIALS AND METHODS. We retrospectively reviewed the HRCT scans of patients with the reversed Halo Sign caused by active tuberculosis and HRCT scans of patients with the reversed Halo Sign caused by COP. The study included 12 patients with active pulmonary tuberculosis (10 women and two men) and 10 patients with biopsy-proven COP (five women and five men). Tuberculosis was diagnosed by culture of sputum, bronchoalveolar lavage, or biopsy specimen. All patients underwent HRCT, and the images were reviewed by two chest radiologists who reached decisions by consensus. RESULTS. HRCT scans of all patients with active tuberculosis showed reversed Halos with nodular walls; in most cases (10/12), we also observed nodules i...
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The reversed Halo Sign on high-resolution CT in infectious and noninfectious pulmonary diseases.
AJR. American journal of roentgenology, 2011Co-Authors: Edson Marchiori, Gláucia Zanetti, Dante Luiz Escuissato, Gustavo De Souza Portes Meirelles, Arthur Soares Souza, Bruno HochheggerAbstract:OBJECTIVE. The purpose of this article is to describe diseases that may present with the reversed Halo Sign on high-resolution CT. We emphasize the tomographic features most frequently associated with this Sign and correlate them with histologic findings. CONCLUSION. A wide spectrum of infectious and noninfectious diseases may present with the reversed Halo Sign on chest CT. The nonspecific nature of this Sign should not cloud an otherwise fairly straightforward diagnosis, especially when associated background findings are typical. Although a rigorous analysis of associated CT findings may help with the differential diagnosis, histologic assessment is often needed for a definitive determination of the cause.
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Psittacosis Presenting as a Halo Sign on High-resolution Computed Tomography
Journal of Thoracic Imaging, 2009Co-Authors: Bruno Hochhegger, Klaus L. Irion, Edson Marchiori, Gustavo Santos De Melo, Flávia Mendes, Gláucia ZanettiAbstract:Psittacosis is an infectious disease caused by the intracellular microorganism Chlamydia psittaci, which mainly affects the respiratory tract. We described the high-resolution computed tomography findings in a 30-year-old man with psittacosis acquired by contact with psittacides. The diagnosis was confirmed by serological methods. High-resolution computed tomography showed nodular opacities surrounded by ground-glass attenuation (Halo Sign) in both lower lobes. Psittacosis should be considered in the differential diagnosis of pulmonary nodules with a Halo Sign in patients with a history of exposure to birds.
Edith M. Marom - One of the best experts on this subject based on the ideXlab platform.
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The reversed Halo Sign: update and differential diagnosis
The British journal of radiology, 2012Co-Authors: Myrna C.b. Godoy, Edson Marchiori, Mylene T. Truong, Chitra Viswanathan, Marcelo F. Benveniste, Santiago E. Rossi, Edith M. MaromAbstract: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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Reversed Halo Sign in pulmonary zygomycosis
Thorax, 2011Co-Authors: Myrna C.b. Godoy, Edith M. MaromAbstract:We read with interest the article ‘The atoll Sign’ by Walsh and Roberton1 in the November issue of Thorax . The authors report a case of cryptogenic organising pneumonia with the atoll Sign, also called the reversed Halo Sign. As mentioned by the authors, this CT Sign was first described in cryptogenic organising pneumonia and was initially considered to be specific for this disease.2 It was subsequently reported in …
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Reversed Halo Sign in Invasive Pulmonary Fungal Infections
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2008Co-Authors: Hisham Wahba, Mylene T. Truong, Xiudong Lei, Dimitrios P. Kontoyiannis, Edith M. MaromAbstract:Computed tomography scans of documented pulmonary mold infections were reviewed for the presence of the reversed Halo Sign, a focus of ground-glass attenuation surrounded by a solid ring. The reversed Halo Sign was an early Sign, seen in ∼4% of patients with pulmonary mold infections, usually with zygomycosis.
