Halo sign (chest)

Changed by Yuranga Weerakkody, 11 Apr 2018

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The halo sign (HS) in chest imaging is a feature seen on lung window settings (typically HRCT), ground glass opacity surrounding a pulmonary nodule or mass and represents haemorrhage. It is typically seen in angioinvasive aspergillosis.

Pathology

Histopathologically, it represents a focus of pulmonary infarction surrounded by alveolar haemorrhage.

Diagnostic considerations

Other entities that may give a halo sign include:

Infectious disease

fungi
septic embolism
mycobacterial
- pulmonary tuberculosis
- pulmonary non-tuberculous mycobacterial infection
  - pulmonary Mycobacterium avium complex infection
rickettsia - rickettsia pneumonia
Coxiella burnetii - Q fever pneumonia
viral: herpes simplex virus, varicella zoster virus (chicken pox), cytomegalovirus, myxovirus

Neoplasia

primary tumours
- adenocarcinoma of lung, adenocarcinoma in situ or minimally invasive (formerly bronchioalveolar carcinoma) - has been described as the most commonly encountered with HS in immunocompetent patients ⁵
- squamous cell carcinoma of lung
- Kaposi sarcoma
- pulmonary lymphoma
lung metastases (especially - haemorrhagic pulmonary metastases):
- angiosarcoma
- choriocarcinoma
- osteosarcoma
- melanoma
- metastasis from gastrointestinal adenocarcinoma (<10%)

Non-neoplastic, non-infectious, inﬂammatory diseases

~~Granulomatosis~~granulomatosis with polyangiitis
eosinophilic lung disease
pulmonary endometriosis
organising pneumonia
hypersensitivity pneumonitis
iatrogenic injury
pulmonary pseudoaneurysm

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