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British Journal of Radiology (2007) 80, e162-e166
© 2007 British Institute of Radiology
doi: 10.1259/bjr/46361210
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Reversed halo sign in lymphomatoid granulomatosis

R E Benamore, MB BChir, MRCP, FRCR 1 G L Weisbrod, MD, FRCPC 1 D M Hwang, MD, PhD, FRCPC 2 D J Bailey, MD, FRCPC 2 A F Pierre, MD, MSc, FRCSC 3 N M Lazar, MD, FRCPC 4 and N Maimon, MD 4

Departments of 1 Medical Imaging, 2 Pathology, 3 Thoracic Surgery and 4 Respirology, Toronto General Hospital, NCSB, 1C- 571, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada


Figure 1
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  		Figure 1. Unenhanced CT of the thorax on lung window settings, November 2003. There are multiple small(approximately 1 cm) nodules throughout the lungs, with no zonal predominance. Some have ill-defined borders and appear to represent air space disease. No significant lymphadenopathy was demonstrated on mediastinal window settings.

 

Figure 2
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  		Figure 2. Unenhanced CT thorax on lung window settings February 2004. The chest radiograph(CXR) from December 2003 was normal. Selected images are at the same anatomical levels as the previous scan. There has been enlargement of the small nodules in both upper lobes and right lower lobe in the posterior costophrenic recess. New nodules are also seen, some of which are coalescing into areas of consolidation in the middle lobe and anterobasal segment of the right lower lobe.

 

Figure 3
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  		Figure 3. Unenhanced CT of the chest, May 2004. There has been significant improvement in the nodules and consolidation, with residual nodular areas of ground glass opacity in the mid and lower zones.

 

Figure 4
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  		Figure 4. (a) Chest radiograph (CXR) July 2005. There are multiple, bilateral, ill-defined nodular air space opacities, with lower zone predominance. Some of these appear to be cavitating on this plain radiograph. (b) Unenhanced CT chest, July 2005. There are multiple opacities, with central areas of ground glass opacity surrounded by denser crescentic consolidation at least 2 mm in thickness. This is described as the reversed halo sign. These areas are admixed with poorly defined nodules. These abnormalities do not all clearly correspond to sites of previous disease involvement.

 

Figure 5
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  		Figure 5. (a) Low-power view shows central areas of air space filling (A) with oedema fluid and foamy histiocytes, surrounded by a denser rim of lymphocytic infiltration (L). (b) High-power views show areas of angioinvasion (I). (c) The inset image shows CD3-positive T cells (darkly staining) completely infiltrating (I) a vessel. The outline of the vessel wall is accentuated by the lack of staining.

 




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