Miriam Menna Barreto1, Edson Marchiori1, Andrea de Brito2, Dante Luiz Escuissato3, Bruno Hochhegger4, Arthur Soares Souza5, Rosana Souza Rodrigues1,6. 1. 1 Department of Radiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 2. 2 Department of Radiology, National Institute of Oncology, Rio de Janeiro, Brazil. 3. 3 Department of Radiology, Federal University of Paraná, Curitiba, Brazil. 4. 4 Department of Radiology, Santa Casa de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. 5. 5 Department of Radiology, Medical School of Rio Preto and Ultra X, São José do Rio Preto/SP, Brazil. 6. 6 D'Or Institute for Research and Education, Rio de Janeiro, Brazil.
Abstract
OBJECTIVE: The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest CT in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease. METHODS: We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analysed the morphological characteristics of the lesions and reached decisions by consensus. RESULTS: We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 17 patients (73.9% of cases). 34 (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%) lesions and irregular/spiculated in 16 (25%) lesions. Ground-glass opacity was observed inside 63 (98.4%) lesions. CONCLUSION: Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas. ADVANCES IN KNOWLEDGE: This is the largest series of patients with RHS due to PCM and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphological characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease.
OBJECTIVE: The purpose of this study was to identify morphological characteristics of the reversed halo sign (RHS) on chest CT in patients with pulmonary paracoccidioidomycosis (PCM) that may aid the diagnosis of this fungal disease. METHODS: We retrospectively reviewed chest CT images from 23 patients with proven pulmonary PCM who demonstrated the RHS. Two chest radiologists analysed the morphological characteristics of the lesions and reached decisions by consensus. RESULTS: We identified 64 RHSs on CT images from the 23 patients. Multiple lesions were observed in all cases, with middle and lower lung zone predominance occurring in 17 patients (73.9% of cases). 34 (53.1%) RHSs were round and 30 (46.9%) were oval. Outer borders of the RHSs were smooth in 32 (50%) lesions, nodular in 16 (25%) lesions and irregular/spiculated in 16 (25%) lesions. Ground-glass opacity was observed inside 63 (98.4%) lesions. CONCLUSION: Our data suggest that morphological characteristics of the RHS on chest CT, such as the presence of multiple lesions, middle and lower lung zone predominance and a spiculated RHS ring, as well as the association with other parenchymal patterns, should lead radiologists to include PCM in the differential diagnosis of PCM in endemic areas. ADVANCES IN KNOWLEDGE: This is the largest series of patients with RHS due to PCM and is also the first study to report RHS lesions with spiculated or irregular walls. The study adds information regarding morphological characteristics of the RHS that may raise suspicion of PCM on chest CT, particularly in endemic areas of the disease.
Authors: David M Hansell; Alexander A Bankier; Heber MacMahon; Theresa C McLoud; Nestor L Müller; Jacques Remy Journal: Radiology Date: 2008-01-14 Impact factor: 11.105
Authors: Miriam M Barreto; Edson Marchiori; Viviane B Amorim; Gláucia Zanetti; Tatiana C Takayassu; Dante L Escuissato; Arthur S Souza; Rosana S Rodrigues Journal: Radiographics Date: 2012 Jan-Feb Impact factor: 5.333
Authors: E Marchiori; R D Grando; C E Simões Dos Santos; L Maffazzioli Santos Balzan; G Zanetti; C M Mano; R S Gutierrez Journal: Br J Radiol Date: 2010-03 Impact factor: 3.039
Authors: Walter de Araujo Eyer-Silva; Annelise Callmann Santana; Guilherme Almeida Rosa da Silva; Marcelo Costa Velho Mendes de Azevedo; Juliana Li Ting Matos Sun Barreto; Marina Apolloni Neumann; Izana Junqueira de Castro; Rodrigo Panno Basílio-de-Oliveira; Luciana Ferreira de Araujo; Nathane Zanineli Ré; Felipe Marques de Oliveira; Caio José de Araujo Simas; Marcos André de Sarvat; Fernando Raphael de Almeida Ferry Journal: IDCases Date: 2017-09-14