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

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Abstract

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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Conflict of interest

Edson Marchiori, Gláucia Zanetti, Bruno Hochhegger, Klaus L Irion, Antonio Carlos Pires Carvalho, and Myrna C. B. Godoy have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Radiology, Federal University of Rio de Janeiro, Rua Thomaz Cameron, 438, Valparaiso, Petrópolis, RJ, CEP 25685.120, Brazil

    Edson Marchiori, Gláucia Zanetti, Bruno Hochhegger & Antonio Carlos Pires Carvalho

  2. Liverpool Heart and Chest Hospital and the Royal Liverpool University Hospital, NHS Trust, Liverpool, UK

    Klaus L Irion

  3. Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

    Myrna C. B. Godoy

Authors
  1. Edson Marchiori
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  2. Gláucia Zanetti
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  3. Bruno Hochhegger
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  4. Klaus L Irion
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  5. Antonio Carlos Pires Carvalho
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  6. Myrna C. B. Godoy
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Correspondence to Edson Marchiori.

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Marchiori, E., Zanetti, G., Hochhegger, B. et al. Reversed Halo Sign on Computed Tomography: State-of-the-Art Review. Lung 190, 389–394 (2012). https://doi.org/10.1007/s00408-012-9392-x

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  • DOI: https://doi.org/10.1007/s00408-012-9392-x

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