Reverse Halo Sign
Jonathan H. Chung, MD
DIFFERENTIAL DIAGNOSIS
Common
Cryptogenic Organizing Pneumonia
Fungal Pneumonia
Invasive Fungal Pneumonia (Aspergillosis, Mucormycosis)
Paracoccidioidomycosis
Bacterial Pneumonia
Less Common
Wegener Granulomatosis
Pulmonary Infarct
Primary Tuberculosis
Sarcoidosis
Tumor
Rare but Important
Lymphomatoid Granulomatosis
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Reverse halo: Central ground-glass opacity surrounded by rim of consolidation
Helpful Clues for Common Diagnoses
Cryptogenic Organizing Pneumonia
Subacute to chronic pulmonary opacities; may be migratory
Mid and lower lung zone, peripheral or peribronchovascular consolidation
Fungal Pneumonia
Invasive Fungal Pneumonia (Aspergillosis, Mucormycosis)
Immunocompromised patients
Voriconazole prophylaxis and history of diabetes suggestive of mucormycosis
Multiple nodular or mass-like areas of consolidation; halo or air crescent sign
Paracoccidioidomycosis
Endemic to South America
Ground-glass opacities, parenchymal bands, centrilobular nodules ± cavitation
Helpful Clues for Less Common Diagnoses
Wegener Granulomatosis
Pulmonary nodules, ± cavitation; subglottic tracheal stenosis
Pulmonary Infarct
Pulmonary emboli; lower lung and peripheral opacities
Primary Tuberculosis
Consolidation, hilar and mediastinal lymphadenopathy, pleural effusion
Sarcoidosis
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