Thoracic Radiology
Evolution of CT characteristics of reversed halo sign in pulmonary tuberculosis
Qiang Jun, Wang Zhaoyu, Jiang Chunlei, Pan Junping, Chen Diansen, Liao Meixiang, Zhen Deqiang, Feng Liancai, Wu Jing
Published 2022-04-10
Cite as Chin J Radiol, 2022, 56(4): 372-376. DOI: 10.3760/cma.j.cn112149-20210409-00347
Abstract
ObjectiveTo explore the evolution of CT characteristics of the "reversed halo sign" of pulmonary tuberculosis, and to further improve the recognition of its CT signs.
MethodsClinical and CT data of 12 patients with pulmonary tuberculosis who were clinically and pathologically confirmed and accompanied with CT manifestation of "reversed halo sign" in First Affiliated Hospital of Henan University of Science and Technology from August 2013 to April 2020 were analyzed retrospectively. Pathological and imaging contrastl analysis was performed on 1 patient undergoing surgical treatment.
ResultsAmong 12 cases with "reversed halo sign", there were 2 cases with single lesion in unilateral lung, 2 cases with multiple lesions in unilateral lung, and 8 cases with multiple lesions in bilateral lungs. Three cases showed only "reversed halo sign", 9 cases showed both halo-like sign and uniform fireworks sign. "Tree-in-bud "sign was found in all 12 patients in the outer ring of the "reversed halo sign". Eight patients received three or more CT examinations, and six of them showed reduction of density and volume of the "reversed halo sign" after standardized anti-tuberculosis treatment. Under the natural course of the disease in two cases, the overall enlargement of the lesion was observed in 1 case, and the overall density of the lesion was reduced and the outer ring wall of the "reversed halo sign" was thinned in 1 case. The pathology of one case after surgical lobectomy showed granulomatous inflammatory nodules of varying sizes containing Langerhans nodule giant cells in the lung parenchyma. The typical caseous necrotic granulomatous nodules were rare here. The "reversed halo sign" showed dense Langerhans nodules in the outer ring, sparse central areas with fibrous hyperplasia and alveolar wall thickening.
ConclusionsThe outer ring of "reversed halo sign" of pulmonary tuberculosis shows as "tree-in-bud" sign, and its center shows as the fine reticulation pattern. After effective anti-tuberculosis treatment, both the overall density of "reversed halo sign" and the lesion size reduced. Finally, the lesions mostly present as as fine grid shadows for a long time.
Key words:
Tuberculosis, pulmonary; Tomography, X-ray computed; Reversed halo sign
Contributor Information
Qiang Jun
Department of Imaging, the First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang 471003, China
Wang Zhaoyu
Department of Pathology, Shanghai Amoydx Medical Center, Shanghai 201112, China
Jiang Chunlei
Department of Radiology, Qingdao 9th People′s Hospital, Qingdao 266002, China
Pan Junping
Department of Imaging, Centre for Tuberculosis Control of Guangdong Province, Guangzhou 510630, China
Chen Diansen
Department of Imaging, the First Affiliated Hospital, College of Clinical Medicine, Medical College of Henan University of Science and Technology, Luoyang 471003, China
Liao Meixiang
Department of Radiology, Lianjiang Feifan Hospital, Zhanjiang 524456, China
Zhen Deqiang
Department of Radiology, TCM Hospital of Qing′an Country, Suihua, 152400, China
Feng Liancai
Department of Respiratory, Rizhao Institute of Tuberculosis Prevention and Control, Rizhao 276800, China
Wu Jing
Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
