65 y/o man with fever and cough



Doctor's Information

Name : Shahram
Family : Kahkouei
Affiliation :Radiology Department, Masih Hospital, SBMU Radiology Department, Masih Hospital, SBMU
Academic Degree : Assistant Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : maryam babaie


Case Section

Chest Imaging


Patient's Information

Gender : Male
Age : 65


Clinical Summary

65 y/o man with fever and cough


Imaging Findings

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'.


Differential Diagnosis

•opportunistic invasive fungal infections
•polyangiits with granulomatosis (Wegener's granulomatosis)
•pneumocystis pneumonia
•community-acquired pneumonia
•lymphomatoid granulomatosis
•lipoid pneumonitis
•pulmonary neoplasms
•pulmonary infarction
•following radiation therapy and radiofrequency/microwave ablation of pulmonary malignancies


Final Diagnosis

angioinvasive aspergillosis


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.


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