Chest > Diagnosis > Overview of Chest Imaging > Chest Radiographic and CT Signs

Reversed Halo Sign

Santiago Martínez-Jiménez, MD

Selected Images Hide Images

Axial CECT of a patient status post Axial NECT of a 25-year-old woman
bilateral lung transplantation with systemic lupus erythematosus
complicated by mucormycosis and organizing pneumonia shows
shows a left upper lobe ground- subpleural consolidations that
glass opacity mass with a peripheral exhibit the reversed halo sign
crescentic consolidation rim , When the peripheral consolidation is
the so-called reversed halo or atoll crescentic, as opposed to
sign. concentric, it is often referred to as
the atoll sign.
Axial CECT of a patient with
pulmonary involvement related to
COVID-19 infection shows
peribronchovascular ground-glass
. opacities. The right lower lobe
nodule exhibits the reversed halo
sign . from the CT halo sign. The latter is
Axial CECT of a 51-year-old man with
acute pulmonary thromboembolism
shows subpleural nodular
consolidations that exhibit the
reversed halo sign. The reversed
halo sign should be differentiated
characterized by central soft tissue
attenuation surrounded by ground-
glass opacity.

Additional Images

Axial CECT of a 43-year-old man with
sarcoidosis shows a right upper lobe
nodular consolidation that exhibits
the reversed halo sign based on the
presence of central ground-glass
opacity surrounded by a rim
of dense consolidation.
Axial NECT of a patient with
cryptogenic organizing pneumonia
shows a right lower lobe mass-like
consolidation that exhibits a ground-
glass opacity center and
peripheral crescentic consolidation
, the reversed halo sign. The sign
is not specific for cryptogenic
organizing pneumonia and can be
present in other lung diseases.
Coronal CECT of a patient with
septic emboli shows multifocal
peripheral nodular opacities
with central ground-glass
attenuation, consistent with the
reversed halo sign.
Axial NECT of a patient with
sarcoidosis shows a right lower lobe
pulmonary nodule that exhibits
the reversed halo sign characterized
by central ground-glass opacity and
a peripheral rim of consolidation.

KEY FACTS

Terminology
Definition: Central ground-glass opacity surrounded by concentric or crescentic consolidation on CT
Synonym: Atoll sign
Atoll: Coral island with central volcano crater
Imaging
Radiography
Nodule, mass, or consolidation
CT
Nodule or mass; rounded, ovoid, slightly lobulated
Ring-shaped or crescentic consolidation with ground-glass opacity center
Top Differential Diagnoses
Organizing pneumonia (idiopathic or from any etiology)
 Fungal infection: Angioinvasive aspergillosis, zygomycosis
(i.e., Mucor and Rhizopus)
Other infections: Bacterial pneumonia, paracoccidioidomycosis, tuberculosis
Acute lung injury secondary to COVID-19
Sarcoidosis, lymphomatoid granulomatosis, granulomatosis with polyangiitis
Neoplasm, infarct
Radiofrequency ablation
Differentiation from CT halo sign: Consolidation with surrounding ground-glass opacity
Etiologies: Angioinvasive fungal disease, granulomatosis with polyangiitis, hemorrhagic metastases
Pathology
Organizing pneumonia
Ring-shaped or crescentic peripheral consolidation corresponds to organizing pneumonia
Central ground-glass opacity corresponds to alveolar septal inflammation and intraalveolar cellular debris
Diagnostic Checklist
Visualization of reversed halo sign should suggest diagnosis of organizing pneumonia
Other entities in differential diagnosis should also be considered

SELECTED REFERENCES

1. Shaghaghi S et al: Target-shaped combined halo and reversed-halo sign, an atypical chest CT finding in COVID-19. Clin Imaging.
69:72-4, 2021
2. McLaren TA et al: The bullseye sign: a variant of the reverse halo sign in COVID-19 pneumonia. Clin Imaging. 68:191-6, 2020
3. Chiarenza A et al: Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-
radiologists. Insights Imaging. 10(1):114, 2019
4. Juan YH et al: Reverse halo sign in pulmonary mucormyosis. QJM. 107(9):777-8, 2014
5. Stewart JI et al: Reverse halo sign on chest imaging in a renal transplant recipient. Transpl Infect Dis. 16(1):115-8, 2014
6. Busca A et al: The reversed halo sign as the initial radiographic sign of pulmonary zygomycosis. Infection. 40(1):77-80, 2012
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8. Marchiori E et al: Reversed halo sign on computed tomography: state-of-the-art review. Lung. 190(4):389-94, 2012
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10. Georgiadou SP et al: The diagnostic value of halo and reversed halo signs for invasive mold infections in compromised hosts. Clin
Infect Dis. 52(9):1144-55, 2011
11. Walker CM et al: "Reversed halo sign". J Thorac Imaging. 26(3):W80, 2011
12. Marchiori E et al: Pulmonary tuberculosis associated with the reversed halo sign on high-resolution CT. Br J Radiol. 83(987):e58-60,
2010
13. Kim SJ et al: Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J
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