View
2.669
Download
3
Embed Size (px)
DESCRIPTION
Ct halo sign (part 1)
Citation preview
Dr Mazen QusaibatyMD, DIS
Head Pulmonary and Internist Department Ibnalnafisse Hospital
Ministry of Syrian healthEmail:
1. CT halo sign (part 1)
2
Topic Outline
1. CT halo sign (part 1)
3
Useful links
http://bjr.birjournals.org
http://radiographics.rsna.org
http://radiology.rsna.org
CT halo sign
CT halo sign
Refers to a zone of ground-glass attenuation (the halo) surrounding a pulmonary nodule or mass or consolidation
5
HRCT of thorax
CT halo sign
Nodular Ground-Glass
Opacity
6
7
Ground glass
Alveolar hemorrhage
8
Ground glass
Alveolar hemorrhage
Infiltration cells
9
Consolidation
Lesion
10
Halo sign could be seen in:
A. AspergillosisB. Eosinophilic PneumoniaC. Bronchiolitis Obliterans with Organizing
PneumoniaD. Thoracic EndometriosisE. Focal Traumatic Lung InjuryF. All above
11
Halo sign could be seen in:
A. AspergillosisB. Eosinophilic PneumoniaC. Bronchiolitis Obliterans with Organizing
PneumoniaD. Thoracic EndometriosisE. Focal Traumatic Lung Injury
F. All above.
12
13
Infectious diseases
14
Aspergillosis
• Aspergillosis may be manifested as areas of nodular ground-glass opacity
http://radiographics.rsna.org/content/27/2/391.full
16
Photomicrograph of a histologic specimen (original magnification, ×100; hematoxylin-eosin stain) shows an aspergillus colony (arrows) and a surrounding
area of intraalveolar hemorrhage (arrowheads)
http://radiographics.rsna.org/content/27/2/391/F24.expansion.html
17
High-power photomicrograph (original magnification, ×1000;
hematoxylin-eosin stain) shows fungal hyphae.
http://radiographics.rsna.org/content/27/2/391/F25.expansion.html
Fungal hyphae
19
High-power photomicrograph (original magnification, ×1000;
hematoxylin-eosin stain) shows fungal hyphae.
http://radiographics.rsna.org/content/27/2/391/F25.expansion.html
20
The clinicopathologic features and radiologic manifestations of aspergillosis depend on
• Patient immunity
http://radiographics.rsna.org/content/27/2/391.full
21
The clinicopathologic features and radiologic manifestations of aspergillosis depend on
• The presence of structural lung disease
http://radiographics.rsna.org/content/27/2/391.full
22
The clinicopathologic features and radiologic manifestations of aspergillosis depend on
• The virulence of the fungal species involved
http://radiographics.rsna.org/content/27/2/391.full
Quiz
• A 50-year-old woman treated with a high dosage of steroids to reduce cerebral edema from anaplastic oligodendroglioma
ي&ات# الد+ب(ق# م/ و1ر1 التغ1ص5ن ل#ي(ل1ة# الق1
23
InvasivePulmonary Aspergillosis
• A large mass is seen in :A. The RULB. The Middle lobeC. The RLL
24
InvasivePulmonary Aspergillosis
• A large mass is seen in :A. The RULB. The Middle lobeC. The RLL
25
InvasivePulmonary Aspergillosis
• A large mass is seen in RUL localized in:A. Apical SegmentB. Posterior SegmentC. Anterior Segment
26
InvasivePulmonary Aspergillosis
• A large mass is seen in RUL localized in:A. Apical SegmentB. Posterior SegmentC. Anterior Segment
27
InvasivePulmonary Aspergillosis
• A large mass is seen in the posterior segment of right upper lobe, surrounded by a wide zone of ground-glass attenuation (arrow)
• Demonstrating the halo sign
28
InvasivePulmonary Aspergillosis
• A smaller mass (arrowhead) is seen in:A. The LLL.B. The LUL.
29
InvasivePulmonary Aspergillosis
• A smaller mass (arrowhead) is seen in:A. The LLL.B. The LUL.
30
InvasivePulmonary Aspergillosis
• A smaller mass (arrowhead) is seen in LLL:A. Superior SegmentB. Lateral Basal SegmentC. Posterior Basal
Segment
31
InvasivePulmonary Aspergillosis
• A smaller mass (arrowhead) is seen in LLL:A. Superior SegmentB. Lateral Basal SegmentC. Posterior Basal
Segment
32
Case
• A 39-year-old man with acute myelogenous leukaemia and neutropenia
33http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Thin-section CT at the level of the lung apex
• Shows multiple nodules surrounded by a halo of ground glass opacity in both upper lobes
34http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Invasive pulmonary aspergillosis
35
• CT shows nodular consolidation associated with a halo of ground-glass opacity (GGO) in both apices resulting from invasive pulmonary aspergillosis
36
• This halo represents hemorrhage.• When seen in leukemic patients, is highly suggestive of the
diagnosis of invasive pulmonary aspergillosis.
Case
• A 45-year-old woman with rapidly progressive glomerulonephritis.
• Low grade fever + mild cough and dyspnea + a weakness
37http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Thin-section CT of the right lung base
• Multiple tiny nodules (arrows) with the CT halo sign in the right lower lobe
38http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Quiz/ This patient has pneumonia caused by:
A. AdenovirusB. CytomegalovirusC. AspergillosisD. Staphylococcus
aureusE. E.Coli
39http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Quiz/ This patient has pneumonia caused by:
A. AdenovirusB. CytomegalovirusC. AspergillosisD. Staphylococcus
aureusE. E.Coli
40http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Neoplastic diseases
41
Kaposi sarcoma in a 29-year-old woman with a history of renal transplantation
• Thin-section CT at the level of the carina
42http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Kaposi sarcoma in a 29-year-old woman with a history of renal transplantation
• shows multiple nodules with a surrounding halo of ground glass opacity in both lungs
43http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Kaposi sarcoma in a 29-year-old woman with a history of renal transplantation
• Flame-shaped lesions
• The classic findings of Kaposi sarcoma.
44http://bjr.birjournals.org/cgi/content/full/78/933/862#T1
Quiz / Thin-section CT obtained at the level of the
A. Bronchus superiorB. Bronchus
intermediusC. Bronchus inferior
45 http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F4
Quiz / Thin-section CT obtained at the level of the
A. Bronchus superiorB. Bronchus
intermediusC. Bronchus inferior
46 http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F4
• A peripheral pulmonary nodule with the CT halo sign
47 http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F4
What diagnosis that do you expect?
A. Streptococcus pneumonia
B. Bronchioloalveolar carcinoma
C. Kaposi SarcomaD. Pneumocystis
carinii (P. jirovecii) pneumonia
48 http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F4
What diagnosis that do you expect?
A. Streptococcus pneumonia
B. Bronchioloalveolar carcinoma
C. Kaposi SarcomaD. Pneumocystis carinii
(P. jirovecii) pneumonia
49 http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F4
Non-neoplastic and non-infectious diseases
50
51
Eosinophilic PneumoniaEosinophilic lung disease may occur in various
conditionsParasitic infection
Idiopathic pulmonary fibrosis
Sarcoidosis
Collagen vascular disease
Hypereosinophilic syndrome
Drug reactions
HayakawaH, Sato A, Toyoshima M, Imokawa S, Taniguchi M. A clinical study of idiopathic eosinophilic pneumonia. Chest 1994; 105:1462–1466.
52
Halo sign / Eosinophilic Pneumonia
Eosinophilic lung disease
Parasitic infection (Loeffler syndrome)
Hypereosinophilic syndrome
HayakawaH, Sato A, Toyoshima M, Imokawa S, Taniguchi M. A clinical study of idiopathic eosinophilic pneumonia. Chest 1994; 105:1462–1466.
53
Histologically
Ground-glass opacity
Intraalveolar exudates Fibrotic change Eosinophilic infiltration
in the interstitium
KimY, Lee KS, Jung KJ, Han J, Kim JS, Suh JS. Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation. J Comput Assist Tomogr 1999; 23: 622–626.
54
Histologically
Solid portion
A neutrophilic abscess
KimY, Lee KS, Jung KJ, Han J, Kim JS, Suh JS. Halo sign on high resolution CT: findings in spectrum of pulmonary diseases with pathologic correlation. J Comput Assist Tomogr 1999; 23: 622–626.
Thin-section CT
• Shows multiple small nodules (arrows) in RLL
with a surrounding halo of ground glass opacity in the right lower lobe
55http://bjr.birjournals.org/cgi/content/full/78/933/862/F6
What diagnosis that do you expect?
A. SarcoidosisB. Idiopathic
pulmonary fibrosisC. Drug reactionsD. Loeffler syndrome
56http://bjr.birjournals.org/cgi/content/full/78/933/862/F6
What diagnosis that do you expect?
A. SarcoidosisB. Idiopathic
pulmonary fibrosisC. Drug reactionsD. Loeffler syndrome
57http://bjr.birjournals.org/cgi/content/full/78/933/862/F6
Simple pulmonary eosinophilia (Loeffler syndrome)
• In a 42-year-old man with peripheral eosinophilia
• 53.5% of eosinophils in the peripheral blood
58http://bjr.birjournals.org/cgi/content/full/78/933/862/F6
Thin-section CT image at the level of the aortic arch
59 http://radiographics.rsna.org/content/27/2/391/F26.expansion.html
An ill-defined area of nodular ground-glass opacity in the upper lobe of the right lung
60 http://radiographics.rsna.org/content/27/2/391/F26.expansion.html
What diagnosis that do you expect in a 36-year-old man?
A. SarcoidosisB. Eosinophilic
pneumonia C. Idiopathic
pulmonary fibrosisD. Drug reactionsE. Lupus
61 http://radiographics.rsna.org/content/27/2/391/F26.expansion.html
What diagnosis that do you expect in a 36-year-old man?
A. SarcoidosisB. Eosinophilic
pneumonia C. Idiopathic
pulmonary fibrosisD. Drug reactionsE. Lupus
62 http://radiographics.rsna.org/content/27/2/391/F26.expansion.html
63
Please don’t forget
Quiz Ground-glass opacity at the level of
A. The left upper lobar bronchus
B. The left lower lobar bronchus
64 http://radiographics.rsna.org/content/27/2/391/F27.expansion.html
Quiz Ground-glass opacity at the level of
A. The left upper lobar bronchus
B. The left lower lobar bronchus
65 http://radiographics.rsna.org/content/27/2/391/F27.expansion.html
MF
Quiz Ground-glass opacity at the level of the left upper lobar
bronchus
A. Apical Posterior Segment
B. Anterior SegmentC. Lingula Superior
SegmentD. Lingula Inferior
Segment
66 http://radiographics.rsna.org/content/27/2/391/F27.expansion.html
Quiz Ground-glass opacity at the level of the left upper lobar
bronchus
A. Apical Posterior Segment
B. Anterior SegmentC. Lingula Superior
SegmentD. Lingula Inferior
Segment
67 http://radiographics.rsna.org/content/27/2/391/F27.expansion.html
LB
Spur LUL
LUL
APSAS
MF
Lingula Inferior Segment
Lingula Superior Segment
Apical Posterior Segment
Anterior Segment
Case
• Thin-section CT shows a pulmonary nodule with the CT halo sign in the left lower lobe (thick arrow).
70http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F5
Note another nodule in without surrounding ground glass opacity (thin arrow) in the:
A. Right middle lobeB. Right upper lobeC. Right lower lobe
71http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F5
Note another nodule in without surrounding ground glass opacity (thin arrow) in the:
A. Right middle lobeB. Right upper lobeC. Right lower lobe
72http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F5
What diagnosis that do you expect?
A. SarcoidosisB. Wegener's
granulomatosisC. Idiopathic
pulmonary fibrosisD. Drug reactionsE. Loeffler syndrome
73http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F5
What diagnosis that do you expect?
A. SarcoidosisB. Wegener's
granulomatosisC. Idiopathic
pulmonary fibrosisD. Drug reactionsE. Loeffler syndrome
74http://bjr.birjournals.org/cgi/content-nw/full/78/933/862/F5
Reverse halo sign
75
76
Reverse halo sign: Wegener's granulomatosis
• Many nodules show central areas of ground glass opacity, with surrounding consolidation.
77
Reverse halo sign: Wegener's granulomatosis
• High-resolution CT scan of the chest shows bilateral nodular opacities with areas of patchy consolidation.