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Vol. 52. Issue 7.
Pages 390 (July 2016)
Vol. 52. Issue 7.
Pages 390 (July 2016)
Clinical Image
DOI: 10.1016/j.arbr.2015.09.019
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Reversed Halo Sign: What Lies Beneath?
Signo del halo invertido: ¿qué hay debajo?
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Luisa María Nascimento
Corresponding author
lu_maria_nascimento@hotmail.com

Corresponding author.
, Ana Fernandes
Servicio de Neumología, Centro Hospitalario de Trás-os-Montes e Alto Douro, Vila Real, Portugal
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We report the case of a 63-year-old man, non-smoker, who presented in the emergency room with acute onset of dyspnea and fever. A chest X-ray showed a roughly nodular opacity in the right perihilar region (Fig. 1A), so the patient was admitted to a medical department with a diagnosis of pneumonia. Due to clinical worsening despite broad-spectrum antibiotic coverage, a chest CT was performed which showed a reversed halo sign (RHS) in the right lung (Fig. 1B). This prompted an extensive investigation including a CT pulmonary angiography that demonstrated the presence of a thrombus in the right main pulmonary artery (Fig. 1C).

Fig. 1.

(A) Chest X-ray showing a roughly nodular opacity in the right perihilar region; (B) Chest CT showing the reversed halo sign; (C) CT pulmonary angiography showing the presence of a thrombus in the right main pulmonary artery.

(0.13MB).

The RHS or atoll sign is characterized by a central ground-glass opacity surrounded by denser air-space consolidation in the shape of a crescent or a ring.1

Although it was initially considered a pathognomonic sign for organizing pneumonia, this manifestation has been associated with a wide range of infectious and non-infectious diseases, including pulmonary embolism (PE).1 In the latter, the RHS seems to correspond to pulmonary infarction in PE2 and diagnosis should be based on clinical and radiological findings.

References
[1]
M. Godoy, C. Viswanathan, E. Marchiori, M. Truong, M. Benveniste, S. Rossi, et al.
The reversed halo sign: update and differential diagnosis.
Br J Radiol, 85 (2012), pp. 1226-1235
[2]
J. Casullo, A. Semionov.
Reversed halo sign in acute pulmonary embolism ad infarction.
Acta Radiol, 54 (2013), pp. 505-510

Please cite this article as: Nascimento LM, Fernandes A. Signo del halo invertido: ¿qué hay debajo?. Arch Bronconeumol. 2016;52:390.

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