Reversed halo sign: Uncommon presentation of a common disease
Identifieur interne : 000338 ( Pmc/Corpus ); précédent : 000337; suivant : 000339Reversed halo sign: Uncommon presentation of a common disease
Auteurs : Bijay Pattnaik ; Pb Sryma ; Saurabh Mittal ; Karan MadanSource :
- Lung India : Official Organ of Indian Chest Society [ 0970-2113 ] ; 2020.
Url:
DOI: 10.4103/lungindia.lungindia_360_19
PubMed: 32108612
PubMed Central: 7065556
Links to Exploration step
PMC:7065556Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Reversed halo sign: Uncommon presentation of a common disease</title><author><name sortKey="Pattnaik, Bijay" sort="Pattnaik, Bijay" uniqKey="Pattnaik B" first="Bijay" last="Pattnaik">Bijay Pattnaik</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Sryma, Pb" sort="Sryma, Pb" uniqKey="Sryma P" first="Pb" last="Sryma">Pb Sryma</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Mittal, Saurabh" sort="Mittal, Saurabh" uniqKey="Mittal S" first="Saurabh" last="Mittal">Saurabh Mittal</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Madan, Karan" sort="Madan, Karan" uniqKey="Madan K" first="Karan" last="Madan">Karan Madan</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32108612</idno><idno type="pmc">7065556</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7065556</idno><idno type="RBID">PMC:7065556</idno><idno type="doi">10.4103/lungindia.lungindia_360_19</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000338</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000338</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Reversed halo sign: Uncommon presentation of a common disease</title><author><name sortKey="Pattnaik, Bijay" sort="Pattnaik, Bijay" uniqKey="Pattnaik B" first="Bijay" last="Pattnaik">Bijay Pattnaik</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Sryma, Pb" sort="Sryma, Pb" uniqKey="Sryma P" first="Pb" last="Sryma">Pb Sryma</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Mittal, Saurabh" sort="Mittal, Saurabh" uniqKey="Mittal S" first="Saurabh" last="Mittal">Saurabh Mittal</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Madan, Karan" sort="Madan, Karan" uniqKey="Madan K" first="Karan" last="Madan">Karan Madan</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Lung India : Official Organ of Indian Chest Society</title><idno type="ISSN">0970-2113</idno><idno type="eISSN">0974-598X</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Maturu, Vn" uniqKey="Maturu V">VN Maturu</name></author><author><name sortKey="Agarwal, R" uniqKey="Agarwal R">R Agarwal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Godoy, Mc" uniqKey="Godoy M">MC Godoy</name></author><author><name sortKey="Viswanathan, C" uniqKey="Viswanathan C">C Viswanathan</name></author><author><name sortKey="Marchiori, E" uniqKey="Marchiori E">E Marchiori</name></author><author><name sortKey="Truong, Mt" uniqKey="Truong M">MT Truong</name></author><author><name sortKey="Benveniste, Mf" uniqKey="Benveniste M">MF Benveniste</name></author><author><name sortKey="Rossi, S" uniqKey="Rossi S">S Rossi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marchiori, E" uniqKey="Marchiori E">E Marchiori</name></author><author><name sortKey="Zanetti, G" uniqKey="Zanetti G">G Zanetti</name></author><author><name sortKey="Hochhegger, B" uniqKey="Hochhegger B">B Hochhegger</name></author><author><name sortKey="Irion, Kl" uniqKey="Irion K">KL Irion</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marchiori, E" uniqKey="Marchiori E">E Marchiori</name></author><author><name sortKey="Zanetti, G" uniqKey="Zanetti G">G Zanetti</name></author><author><name sortKey="Mano, Cm" uniqKey="Mano C">CM Mano</name></author><author><name sortKey="Hochhegger, B" uniqKey="Hochhegger B">B Hochhegger</name></author><author><name sortKey="Irion, Kl" uniqKey="Irion K">KL Irion</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Marchiori, E" uniqKey="Marchiori E">E Marchiori</name></author><author><name sortKey="Zanetti, G" uniqKey="Zanetti G">G Zanetti</name></author><author><name sortKey="Irion, Kl" uniqKey="Irion K">KL Irion</name></author><author><name sortKey="Nobre, Lf" uniqKey="Nobre L">LF Nobre</name></author><author><name sortKey="Hochhegger, B" uniqKey="Hochhegger B">B Hochhegger</name></author><author><name sortKey="Mancano, Ad" uniqKey="Mancano A">AD Mançano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nattusamy, L" uniqKey="Nattusamy L">L Nattusamy</name></author><author><name sortKey="Madan, K" uniqKey="Madan K">K Madan</name></author><author><name sortKey="Bhalla, As" uniqKey="Bhalla A">AS Bhalla</name></author><author><name sortKey="Guleria, R" uniqKey="Guleria R">R Guleria</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="letter"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Lung India</journal-id><journal-id journal-id-type="iso-abbrev">Lung India</journal-id><journal-id journal-id-type="publisher-id">LI</journal-id><journal-title-group><journal-title>Lung India : Official Organ of Indian Chest Society</journal-title></journal-title-group><issn pub-type="ppub">0970-2113</issn><issn pub-type="epub">0974-598X</issn><publisher><publisher-name>Wolters Kluwer - Medknow</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32108612</article-id><article-id pub-id-type="pmc">7065556</article-id><article-id pub-id-type="publisher-id">LI-37-182</article-id><article-id pub-id-type="doi">10.4103/lungindia.lungindia_360_19</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Letter</subject></subj-group></article-categories><title-group><article-title>Reversed halo sign: Uncommon presentation of a common disease</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Pattnaik</surname><given-names>Bijay</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Sryma</surname><given-names>PB</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Mittal</surname><given-names>Saurabh</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Madan</surname><given-names>Karan</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Pulmonary, Critical Care and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India. E-mail:<email xlink:href="drkaranmadan@gmail.com">drkaranmadan@gmail.com</email></italic></aff><pub-date pub-type="ppub"><season>Mar-Apr</season><year>2020</year></pub-date><pub-date pub-type="epub"><day>27</day><month>2</month><year>2020</year></pub-date><volume>37</volume><issue>2</issue><fpage>182</fpage><lpage>183</lpage><history><date date-type="received"><day>07</day><month>8</month><year>2019</year></date><date date-type="accepted"><day>09</day><month>9</month><year>2019</year></date></history><permissions><copyright-statement>Copyright: © 2020 Indian Chest Society</copyright-statement><copyright-year>2020</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/4.0"><license-p>This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.</license-p></license></permissions></article-meta></front><body><p>Sir,</p><p>A 41-year-old never-smoker female presented with a history of gradually progressive dyspnea, dry cough, and low-grade fever of 4 weeks' duration. The patient was a known case of Sjogren's syndrome and was on treatment with oral hydroxychloroquine. There was no history of hemoptysis, loss of weight, or appetite. There was no significant environmental exposure or occupational history. General physical and respiratory examination was normal. A posteroanterior chest radiograph demonstrated bilateral lower zone alveolar opacities, suggestive of bilateral basal consolidation. High-resolution computed tomography (CT) scan of the thorax [<xref ref-type="fig" rid="F1">Figure 1</xref>] revealed bilateral lower lobe consolidations with some areas, demonstrating central ground-glass opacity, typical of the reversed halo sign. Investigations revealed normal hemogram with a normal absolute eosinophil count (272/mm<sup>3</sup>) and normal liver and renal function tests. In view of the classical radiological appearance and coexistent autoimmune disease, organizing pneumonia was considered as the first clinicoradiological possibility.</p><fig id="F1" position="float"><label>Figure 1</label><caption><p>High-resolution computed tomography thorax image (lung window section) showing bilateral lower lobe consolidation with central ground-glass opacity and denser peripheral rim of consolidation suggestive of reversed halo sign</p></caption><graphic xlink:href="LI-37-182-g001"></graphic></fig><p>The reversed halo sign or atoll sign is characterized by a central ground-glass opacity surrounded by a more or less complete ring of denser consolidation. Histopathologically, the central ground-glass indicates alveolar septal inflammation with intact alveolar air spaces. The denser rim is due to inflammation/granulation tissue within the air space itself.[<xref rid="ref1" ref-type="bibr">1</xref>] Initially, considered typical for cryptogenic organizing pneumonia (COP), this radiological sign has also been described in other diseases, such as invasive fungal infections, pneumocystis pneumonia, tuberculosis, lipoid pneumonia, granulomatosis with polyangiitis, and sarcoidosis.[<xref rid="ref2" ref-type="bibr">2</xref>] In most patients, a histopathological diagnosis may be warranted due to a broad list of differential diagnoses. Options in this patient to obtain a tissue diagnosis would include either a bronchoscopy-centered approach with bronchoalveolar lavage and transbronchial lung biopsy (TBLB) or an image-guided biopsy (CT-guided biopsy). In view of diffuse lower lobe involvement and favorable safety profile with the bronchoscopic approach (lower risk of pneumothorax), TBLB was planned in our patient. The patient underwent flexible bronchoscopy and TBLB from the right lower lobe. Histopathological examination of the lung biopsy showed reticulin-rich nonnecrotizing epithelioid cell granulomas. Serum angiotensin-converting enzyme levels were mildly elevated, and tuberculin skin test demonstrated no induration.</p><p>A diagnosis of pulmonary sarcoidosis was established. In view of symptomatic disease, the patient was started on treatment with oral corticosteroids (0.75 mg/kg of prednisolone daily for 4 weeks), gradually tapered over the next 9 months. The patient experienced good symptomatic improvement, repeat chest radiograph at 2 months of treatment showed improvement, and follow-up radiograph following treatment completion was normal [<xref ref-type="fig" rid="F2">Figure 2</xref>]. The patient remains asymptomatic after stopping steroids and is under follow-up for 3 years posttreatment with no relapse.</p><fig id="F2" position="float"><label>Figure 2</label><caption><p>Chest radiograph (pretreatment) showing bilateral basal alveolar opacities (left panel), post-2 months' treatment radiograph (middle panel) showing improvement, and follow-up radiograph (right panel) showing complete clearance of consolidations and a normal radiographic appearance</p></caption><graphic xlink:href="LI-37-182-g002"></graphic></fig><p>Reversed halo sign is an atypical CT sign for pulmonary sarcoidosis.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref4" ref-type="bibr">4</xref>] The presence of nodular walls or nodules inside the reversed halo indicates granulomatous disease processes such as active pulmonary tuberculosis as well as sarcoidosis and helps in differentiating from COP.[<xref rid="ref3" ref-type="bibr">3</xref><xref rid="ref5" ref-type="bibr">5</xref><xref rid="ref6" ref-type="bibr">6</xref>] However, this may not be present in all cases. In an immunocompromised patient, the presence of reversed halo sign on CT should alert a clinician to consider the possibility of invasive fungal infection. In an immunocompetent host like the index patient, it is important to establish a conclusive diagnosis before initiating treatment as this sign is associated with both infectious and noninfectious diseases, for which the treatment approaches may differ.</p><sec disp-level="2" id="sec2-1"><title>Declaration of patient consent</title><p>The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.</p></sec><sec disp-level="2" id="sec2-2"><title>Financial support and sponsorship</title><p>Nil.</p></sec><sec disp-level="2" id="sec2-3" sec-type="COI-statement"><title>Conflicts of interest</title><p>There are no conflicts of interest.</p></sec></body><back><ref-list><title>REFERENCES</title><ref id="ref1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maturu</surname><given-names>VN</given-names></name><name><surname>Agarwal</surname><given-names>R</given-names></name></person-group><article-title>Reversed halo sign: A systematic review</article-title><source>Respir Care</source><year>2014</year><volume>59</volume><fpage>1440</fpage><lpage>9</lpage><pub-id pub-id-type="pmid">24782557</pub-id></element-citation></ref><ref id="ref2"><label>2</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Godoy</surname><given-names>MC</given-names></name><name><surname>Viswanathan</surname><given-names>C</given-names></name><name><surname>Marchiori</surname><given-names>E</given-names></name><name><surname>Truong</surname><given-names>MT</given-names></name><name><surname>Benveniste</surname><given-names>MF</given-names></name><name><surname>Rossi</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>The reversed halo sign: Update and differential diagnosis</article-title><source>Br J Radiol</source><year>2012</year><volume>85</volume><fpage>1226</fpage><lpage>35</lpage><pub-id pub-id-type="pmid">22553298</pub-id></element-citation></ref><ref id="ref3"><label>3</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marchiori</surname><given-names>E</given-names></name><name><surname>Zanetti</surname><given-names>G</given-names></name><name><surname>Hochhegger</surname><given-names>B</given-names></name><name><surname>Irion</surname><given-names>KL</given-names></name></person-group><article-title>Sarcoidosis and the reversed halo sign</article-title><source>Radiographics</source><year>2011</year><volume>31</volume><fpage>892</fpage><lpage>3</lpage><pub-id pub-id-type="pmid">21571664</pub-id></element-citation></ref><ref id="ref4"><label>4</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marchiori</surname><given-names>E</given-names></name><name><surname>Zanetti</surname><given-names>G</given-names></name><name><surname>Mano</surname><given-names>CM</given-names></name><name><surname>Hochhegger</surname><given-names>B</given-names></name><name><surname>Irion</surname><given-names>KL</given-names></name></person-group><article-title>The reversed halo sign: Another atypical manifestation of sarcoidosis</article-title><source>Korean J Radiol</source><year>2010</year><volume>11</volume><fpage>251</fpage><lpage>2</lpage><pub-id pub-id-type="pmid">20191076</pub-id></element-citation></ref><ref id="ref5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Marchiori</surname><given-names>E</given-names></name><name><surname>Zanetti</surname><given-names>G</given-names></name><name><surname>Irion</surname><given-names>KL</given-names></name><name><surname>Nobre</surname><given-names>LF</given-names></name><name><surname>Hochhegger</surname><given-names>B</given-names></name><name><surname>Mançano</surname><given-names>AD</given-names></name><etal></etal></person-group><article-title>Reversed halo sign in active pulmonary tuberculosis: Criteria for differentiation from cryptogenic organizing pneumonia</article-title><source>AJR Am J Roentgenol</source><year>2011</year><volume>197</volume><fpage>1324</fpage><lpage>7</lpage><pub-id pub-id-type="pmid">22109285</pub-id></element-citation></ref><ref id="ref6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Nattusamy</surname><given-names>L</given-names></name><name><surname>Madan</surname><given-names>K</given-names></name><name><surname>Bhalla</surname><given-names>AS</given-names></name><name><surname>Guleria</surname><given-names>R</given-names></name></person-group><article-title>Reversed halo sign in active pulmonary tuberculosis</article-title><source>BMJ Case Rep</source><year>2014</year><volume>2014</volume><fpage>pii: bcr2013202981</fpage></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Sante/explor/ChloroquineV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 000338 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 000338 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Sante
|area= ChloroquineV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé= PMC:7065556
|texte= Reversed halo sign: Uncommon presentation of a common disease
}}
Pour générer des pages wiki
HfdIndexSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/RBID.i -Sk "pubmed:32108612" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd \
| NlmPubMed2Wicri -a ChloroquineV1
| This area was generated with Dilib version V0.6.33. |  |