Name : Shahram
Family : Kahkouei
Affiliation :Radiology Department, Masih Hospital, SBMU Radiology Department, Masih Hospital, SBMU
Academic Degree : Assistant Professor of Radiology
Resident : maryam babaie
Gender : Male
Age : 65
65 y/o man with fever and cough
There are multiple ovoid lesions in the both lung fields, which demonstrate central ground-glass density surrounded by peripheral consolidation. The appearances are consistent with an 'atoll-sign' or 'reversed halo sign'.
•opportunistic invasive fungal infections
•polyangiits with granulomatosis (Wegener's granulomatosis)
•following radiation therapy and radiofrequency/microwave ablation of pulmonary malignancies
Discussion (Related Text)
The reversed halo sign is a focal rounded area of ground-glass opacity surrounded by a crescent or complete ring of consolidation. In severely immunocompromised patients, these signs are highly suggestive of early infection by an angioinvasive fungus. The halo sign and reversed halo sign are most commonly associated with invasive pulmonary aspergillosis and pulmonary mucormycosis, respectively. Many other infections and noninfectious conditions, such as neoplastic and inflammatory processes, may also manifest with pulmonary nodules associated with either sign. Although nonspecific, both signs can be useful for preemptive initiation of antifungal therapy in the appropriate clinical setting. This review aims to evaluate the diagnostic value of the halo sign and reversed halo sign in immunocompromised hosts and describes the wide spectrum of diseases associated with them.
Clin Infect Dis. 2011 May;52(9):1144-55. doi: 10.1093/cid/cir122.