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Weekly Chest CasesImaging Conference Cases

Case No : 9

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  • Age/Sex 26 / F
  • Case Title Acute lymphocytic leukemia patient
  • Figure 1
  • Figure 2

Admission day #28

Diagnosis With Brief Discussion

Courtesy
Seoul National University Hospital, Korea
Lab
WBC 172,500 (blast 20%)
Definitive Diagnosis
Surgical excision
Differential Diagnosis
BOOP
(Acta Radiol 1996;37:889-892, AJR 2003; 180:1251-1254)

Paracoccidioidomycosis
(AJR 2005; 184:1932-1934)

Wegener's granulomatosis

Past History
Sarted chemotherapy on #10 day
Reviewy
BOOP canexhibit specific CT features with regard to the crescentic or ring-shapedopacities with a central groundglass attenuation area. Since these featureshave not been described in any other disease, they might be characteristicfeatures for the diagnosis of BOOP. (Acta Radiol1996;37:889-892)
The reversedhalo sign was identified in the upper lungzone ,middle lung zone and lower lung zone in six (19%) of 31 patients withcryptogenic organizing pneumonia. The sign was not found on CT in any patientswith Wegener's granulomatosis, diffuse bronchioloalveolar carcinoma, chroniceosinophilic pneumonia, or Churg-Strauss syndrome. The frequency ofvisualization of the reversed halo sign in cryptogenic organizing pneumoniawas statistically significant compared with that of the other diseases. (AJR 2003; 180:1251-1254)
One case- herbal medicine sho-seiryu to induced interstitial pneumonia (Hata Y et al. Nihon Kokyuki Gakkai Zasshi2005)
The reversed halo sign is seen in approximately 10% of patients with paracoccidioidomycosis. In these patients, this sign reflects the presence of a central area of predominantly interstitial inflammation surrounded by predominantly air-space infiltration. ….the reversed halo sign can be seen in patients with active infection and without organizing pneumonia. (AJR 2005; 184:1932-1934)
Keywords
Lung, Infection, Fungal infection, Angioinvasive aspergillosis, Invasive Aspergillosis with Reversed Halo Sign (Atoll Sign)
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