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Original Research: IMAGING |

Reversed Halo SignReversed Halo Sign on High-Resolution CT Scan: High-Resolution CT Scan Findings in 79 Patients

Edson Marchiori, MD, PhD; Gláucia Zanetti, MD, PhD; Dante Luiz Escuissato, MD, PhD; Arthur Soares Souza, Jr, MD, PhD; Gustavo de Souza Portes Meirelles, MD, PhD; Joana Fagundes, MD; Carolina Althoff Souza, MD, PhD; Bruno Hochhegger, MD, PhD; Edith M. Marom, MD; Myrna C. B. Godoy, MD
Author and Funding Information

From the Federal University of Rio de Janeiro (Drs Marchiori, Zanetti, Fagundes, and Hochhegger), Rio de Janeiro; the Federal University of Parana (Dr Escuissato), Curitiba; the Faculty of Medicine of São José do Rio Preto (Dr A. S. Souza Jr), São José do Rio Preto; and the São Paulo Federal University (Dr Meirelles), São Paulo, Brazil; the Ottawa Hospital (Dr C. A. Souza), Ottawa, ON, Canada; and the University of Texas MD Anderson Cancer Center (Drs Marom and Godoy), Houston, Texas.

Correspondence to: Edson Marchiori, MD, PhD, Rua Thomaz Cameron, 438, Valparaiso, CEP 25685.120, Petrópolis, Rio de Janeiro, Brazil; e-mail: edmarchiori@gmail.com.


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1260-1266. doi:10.1378/chest.11-1050
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Background:  The purpose of this study was to evaluate the high-resolution CT (HRCT) scan findings of patients with the reversed halo sign (RHS) and to identify distinguishing features among the various causes.

Methods:  Two chest radiologists reviewed the HRCT scans of 79 patients with RHS and determined the CT scan findings by consensus. We studied the morphologic characteristics, number of lesions, and presence of features associated with RHS.

Results:  Forty-one patients presented with infectious diseases (paracoccidioidomycosis, TB, zygomycosis, invasive pulmonary aspergillosis, Pneumocystis jiroveci pneumonia, histoplasmosis, cryptococcosis), and 38 presented with noninfectious diseases (cryptogenic organizing pneumonia, pulmonary embolism, sarcoidosis, edema, lepidic predominant adenocarcinoma [formerly bronchiolo-alveolar carcinoma], granulomatosis with polyangiitis [Wegener]). The RHS walls were smooth in 58 patients (73.4%) and nodular in 21 patients (26.6%). Lesions were multiple in 40 patients (50.6%) and single in 39 patients (49.4%).

Conclusion:  The presence of nodular walls or nodules inside the halo of the RHS is highly suggestive of granulomatous diseases.

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