대한흉부영상의학회 Weekly Chest Cases

Courtesy of Won Gi Jeon / Chonnam National University Hwasun Hospital
Age/Sex 66 / M
Chief ComplaintChief complaint: Incidentally detected pulmonary mass Past history: Endoscopic submucosal dissection (ESD) due to early gastric cancer

initial

Diagnosis: Pulmonary tuberculosis
Radiologic Findings: Fig 1. High-resolution CT image shows approximately 4.5 cm mass in the left lower lobe. The mass has central ground-glass attenuation surrounded by consolidation (reversed halo sign). Nodular walls and nodules inside the halo of the reversed halo sign are noted.
Figs 2-4. The mass do not show reversed halo appearance on follow-up CT after 3 years. New solid nodules are detected in the right middle lobe and right lower lobe.
Brief Review: On surgical specimen, most of the lesions showed necrosis and TB-PCR was positive.
The ��reversed halo�� sign shown by high-resolution CT (HRCT) is defined as a focal, rounded area of ground-glass opacity surrounded by a nearly complete ring of consolidation. Cryptogenic organizing pneumonia (COP) is described as the most common cause of the reversed halo sign and this pattern can also occur in active tuberculosis. The presence of nodular walls or nodules inside the halo of the reversed halo sign is highly suggestive of granulomatous diseases, especially tuberculosis, rather than of COP. The nodular reversed halo sign should be included among the HRCT findings that are suggestive of active tuberculosis.
References: Marchiori E, Zanetti G, Irion KL, Nobre LF, Hochhegger B, Man
Keywords: Pulmonary tuberculosis,

대한흉부영상의학회 Korean Society of Thoracic Radiology