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LETTER TO THE EDITOR |
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| Year : 2014 | Volume
: 9
| Issue : 1 | Page : 48 |
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| The reversed halo sign extending the spectrum of atypical radiological manifestations in sarcoidosis |
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Edson Marchiori1, Gláucia Zanetti1, Marcos Duarte Guimarães2, Bruno Hochhegger1
1 Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
2 Department of Radiology, Hospital A.C. Camargo, São Paulo, Brazil
| Date of Web Publication | 6-Jan-2014 |
Correspondence Address:
Edson Marchiori
Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1817-1737.124445
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How to cite this article:
Marchiori E, Zanetti G, Guimarães 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, Guimarães MD, Hochhegger B. The reversed halo sign extending the spectrum of atypical radiological manifestations in sarcoidosis. Ann Thorac Med [serial online] 2014 [cited 2023 Mar 29];9:48. Available from: https://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 | |  |
| 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. 
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| 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.
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| 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.
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| 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.
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| 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.
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| This article has been cited by | | 1 |
The Clinical Features of Sarcoidosis: A Comprehensive Review |
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| Marc A. Judson | | Clinical Reviews in Allergy & Immunology. 2014; | | [Pubmed] | [DOI] | |
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