Annals of Thoracic Medicine Official publication of the Saudi Thoracic Society, affiliated to King Saud University
 
Search Ahead of print Current Issue Archives Instructions Subscribe e-Alerts Login 
Home Email this article link Print this article Bookmark this page Decrease font size Default font size Increase font size


 
Table of Contents   
LETTER TO THE EDITOR
Year : 2014  |  Volume : 9  |  Issue : 1  |  Page : 48
The reversed halo sign extending the spectrum of atypical radiological manifestations in sarcoidosis


1 Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
2 Department of Radiology, Hospital A.C. Camargo, S„o Paulo, Brazil

Date of Web Publication6-Jan-2014

Correspondence Address:
Edson Marchiori
Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro
Brazil
Login to access the Email id


DOI: 10.4103/1817-1737.124445

PMID: 24551020

Rights and Permissions



How to cite this article:
Marchiori E, Zanetti G, Guimar„es MD, Hochhegger B. The reversed halo sign extending the spectrum of atypical radiological manifestations in sarcoidosis. Ann Thorac Med 2014;9:48

How to cite this URL:
Marchiori E, Zanetti G, Guimar„es MD, Hochhegger B. The reversed halo sign extending the spectrum of atypical radiological manifestations in sarcoidosis. Ann Thorac Med [serial online] 2014 [cited 2020 Jan 26];9:48. Available from: http://www.thoracicmedicine.org/text.asp?2014/9/1/48/124445


Sir,

We read with great interest the well-written pictorical essay by Al-Jahdali et al., [1] which reviews the wide spectrum of atypical thoracic manifestations of sarcoidosis on imaging methods, emphasizing the importance of understanding the radiological manifestations in making a proper diagnosis.

In order to contribute to this excellent review, we would like to include another atypical tomographic aspect of sarcoidosis, which is the reversed halo sign (RHS). RHS is defined as a focal, round area of ground-glass attenuation surrounded by a partial or complete rim of consolidation. This sign was initially described as a relatively specific of cryptogenic organizing pneumonia. However, subsequent publications identified this sign in a wide spectrum of diseases, including infectious and non-infectious conditions, among them pulmonary sarcoid is included. [2],[3]

Although the RHS must be regarded as a non-specific sign that is encountered in various pulmonary diseases, in cases of sarcoidosis the sign has distinctive morphological characteristics. In patients with sarcoidosis, the ring or the inner area of the reversed halo is nodular in appearance. Furthermore, small nodules within the central ground-glass region of the RHS were seen. Histopathologic analysis of such specimens has revealed the presence of granulomas within the ring portion of the RHS and/or inside the RHS. [4],[5] The same aspect was seen in active granulomatous infectious diseases, particularly tuberculosis. [5] In conclusion, the RHS with nodular pattern should be included in the spectrum of parenchymal abnormalities that are observed on high resolution computed tomography in patients with sarcoidosis.

 
   References Top

1.Al-Jahdali H, Rajiah P, Koteyar SS, Allen C, Khan AN. Atypical radiological manifestations of thoracic sarcoidosis: A review and pictorial essay. Ann Thorac Med 2013;8:186-96.  Back to cited text no. 1
  Medknow Journal  
2.Marchiori E, Zanetti G, Escuissato DL, Souza AS Jr, Meirelles GS, Fagundes J, et al. Reversed halo sign: High-resolution CT scan findings in 79 patients. Chest 2012;141:1260-6.  Back to cited text no. 2
    
3.Marchiori E, Zanetti G, Meirelles GS, Escuissato DL, Souza AS Jr, Hochhegger B. The reversed halo sign on high-resolution CT in infectious and noninfectious pulmonary diseases. AJR Am J Roentgenol 2011;197:W69-75.  Back to cited text no. 3
    
4.Marchiori E, Zanetti G, Mano CM, Hochhegger B, Irion KL. The reversed halo sign: Another atypical manifestation of sarcoidosis. Korean J Radiol 2010;11:251-2.  Back to cited text no. 4
    
5.Marchiori E, Zanetti G, Hochhegger B, Irion KL. Re: Reversed halo sign: Nodular wall as criterion for differentiation between cryptogenic organizing pneumonia and active granulomatous diseases. Clin Radiol 2010;65:770-1.  Back to cited text no. 5
    



This article has been cited by
1 The Clinical Features of Sarcoidosis: A Comprehensive Review
Marc A. Judson
Clinical Reviews in Allergy & Immunology. 2014;
[Pubmed] | [DOI]



 

Top
Print this article  Email this article
 
  Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (237 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    References

 Article Access Statistics
    Viewed1356    
    Printed28    
    Emailed0    
    PDF Downloaded310    
    Comments [Add]    
    Cited by others 1    

Recommend this journal