1887
3 - The International and Scientific Conference of Alnahrain College of Medicine and Colleges of Medicine in Iraq confronting COVID-19 Pandemic (ISMC-2022)
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

The reversed halo sign described in the pre-COVID era in certain pulmonary pathologies, most notably cryptogenic organizing pneumonia, has been reported with varying frequency in coronavirus disease 2019 (COVID-19) pneumonia caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we aimed to analyze the pattern of the reversed halo sign and its variant, the bullseye sign in patients with COVID-19 pneumonia. In this study, a retrospective analysis of chest CT scans performed in the CT unit of Al-Imammain Al-Kadhymain Medical City for a three-month duration (from June to August 2020) was done. Of the 490 CT scans performed for patients with COVID-19, 330 had signs of COVID-19 pneumonia. These were evaluated for the presence of reversed halo or bullseye sign, and only obvious signs detected in at least two orthogonal planes were included. The number of these signs in each scan was documented, and an analysis of individual signs was performed. The following features were recorded; size, location, shape, and type of the peripheral rim (whether complete or incomplete, thin or thick, distinct or hazy, and uniform or non-uniform). A total of 26 CT exams were included in the study. The average age of the patients was 44.85 ± 20.14 years, and the total number of typical reversed halo or bullseye sign lesions was 63. The rate of reversed halo/bullseye sign in this study was 7.88%. In 15 patients, the typical sign of reversed halo was seen, the bullseye sign was noted in eight patients, and three patients had both the reversed halo and bullseye signs. Nearly all the patients had other CT findings of COVID-19 pneumonia, except one with only a solitary bullseye lesion. The number of lesions ranged from one to nine with the average number of lesions per patient being 2.42. The mean size of the lesions was 3.39 cm with a size range 1–8.5 cm. Lesions were located in the periphery of the lung in most patients (93.7%). Basal predominance was seen in 76.19% patients, located in the lower lobes. A higher percent of bullseye lesions located in the upper and right middle lobes was observed (n = 12/23) than the typical reversed halo lesions (n = 3/40). Most lesions were oval (52.38%) or rounded (48.86%). In 77.78%, the peripheral rim was incomplete. The thickness of the peripheral rim was variable ranging from 2–19 mm. Most lesions (92.06%) exhibited a thin peripheral rim ( < 1 cm). The rim was clearly distinct in 53.97% of lesions. It was non-uniform in thickness in most cases (95.24%). The reversed halo sign is not infrequent among CT findings in patients with COVID-19 pneumonia. The typical reversed halo sign is more common than its variant, the bullseye sign. Variability in morphology and size does exist. In patients with COVID-19, these lesions exhibit thin, incomplete peripheral rims and are multiple in most cases.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2022.ismc.9
2022-06-06
2022-06-30
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2022/3/jemtac.2022.ismc.9.html?itemId=/content/journals/10.5339/jemtac.2022.ismc.9&mimeType=html&fmt=ahah

References

  1. Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020 382:(8):727–33. doi: 10.1056/NEJMoa2001017.
    [Google Scholar]
  2. Tan W, Zhao X, Ma X, et al. A novel coronavirus genome identified in a cluster of pneumonia cases (Wuhan, China 2019–2020. China CDC Wkly. 2020 2:(4):61–2.
    [Google Scholar]
  3. World Health Organization. Director-General's opening remarks at the media briefing on COVID-19 on 11 March 2020. [Internet]. WHO; 2021 [Accessed April 26, 2022]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19–-11-march-2020..
    [Google Scholar]
  4. Kwee TC, Kwee RM. Chest CT in COVID-19: What the radiologist needs to know [published correction appears in Radiographics. 2022 Jan–Feb; 42:(1):E32. Radiographics. 2020 40:(7):1848–65. doi: 10.1148/rg.2020200159..
    [Google Scholar]
  5. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020 215:(1):87–93. doi: 10.2214/AJR.20.23034..
    [Google Scholar]
  6. Bayraktaroğlu S, Çinkooğlu A, Ceylan N, Savaş R. The novel coronavirus pneumonia (COVID-19): a pictorial review of chest CT features. Diagn Interv Radiol. 2021 27:(2):188–94. doi: 10.5152/dir.2020.20304..
    [Google Scholar]
  7. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology. 2020 296:(2):E32–E40. doi: 10.1148/radiol.2020200642..
    [Google Scholar]
  8. Wu Y, Xie YL, Wang X. Longitudinal CT findings in COVID-19 pneumonia: case presenting organizing pneumonia pattern. Radiol Cardiothorac Imaging. 2020 2:(1):e200031. doi: 10.1148/ryct.2020200031..
    [Google Scholar]
  9. Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020 295:(3):200463. doi: 10.1148/radiol.2020200463..
    [Google Scholar]
  10. Farias LPG, Strabelli DG, Sawamura MVY. COVID-19 pneumonia and the reversed halo sign. J Bras Pneumol. 2020 46:(2):e20200131. doi: 10.36416/1806-3756/e20200131..
    [Google Scholar]
  11. Campagnano S, Angelini F, Fonsi GB, Novelli S, Drudi FM. Diagnostic imaging in COVID-19 pneumonia: a literature review. J Ultrasound. 2021 24:(4):383–95. doi: 10.1007/s40477-021-00559-x..
    [Google Scholar]
  12. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008 246:(3):697–722. doi: 10.1148/radiol.2462070712..
    [Google Scholar]
  13. Marchiori E, Zanetti G, Meirelles GS, Escuissato DL, Souza AS Jr, Hochhegger B. The reversed halo sign on high-resolution CT in infectious and noninfectious pulmonary diseases. AJR Am J Roentgenol. 2011 197:(1):W69–W75. doi: 10.2214/AJR.10.5762..
    [Google Scholar]
  14. Godoy MC, Viswanathan C, Marchiori E, et al. The reversed halo sign: update and differential diagnosis. Br J Radiol. 2012 85:(1017):1226–35. doi: 10.1259/bjr/54532316..
    [Google Scholar]
  15. McLaren TA, Gruden JF, Green DB. The bullseye sign: a variant of the reverse halo sign in COVID-19 pneumonia. Clin Imaging. 2020;:68:191–96. doi: 10.1016/j.clinimag.2020.07.024..
    [Google Scholar]
  16. Müller CIS, Müller NL. Chest CT target sign in a couple with COVID-19 pneumonia. Radiol Bras. 2020 53:(4):252–54. doi: 10.1590/0100-3984.2020.0089..
    [Google Scholar]
  17. Gomes de Farias LP, Caixeta Souza FH, da Silva Teles GB. The target sign and its variant in COVID-19 pneumonia. Radiol Cardiothorac Imaging. 2020 2:(4):e200435. doi: 10.1148/ryct.2020200435..
    [Google Scholar]
  18. Shaghaghi S, Daskareh M, Irannejad M, Shaghaghi M, Kamel IR. Target-shaped combined halo and reversed-halo sign, an atypical chest CT finding in COVID-19. Clin Imaging. 2021;:69:72–4. doi: 10.1016/j.clinimag.2020.06.038.
    [Google Scholar]
  19. Giannakis A, Móré D, Mangold DL, et al. Simultaneous presence of the “bullseye” and “reversed halo” sign at CT of COVID-19 pneumonia: A case report. source>Radiol Case Rep. 2021 16:(9):2442–6. doi: 10.1016/j.radcr.2021.05.074.
    [Google Scholar]
  20. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. AJR Am J Roentgenol. 2020 214:(6):1280–6. doi: 10.2214/AJR.20.22954..
    [Google Scholar]
  21. Wang J, Xu Z, Wang J, et al. CT characteristics of patients infected with 2019 novel coronavirus: association with clinical type. Clin Radiol. 2020 75:(6):408–14. doi: 10.1016/j.crad.2020.04.001..
    [Google Scholar]
  22. Adams HJA, Kwee TC, Yakar D, Hope MD, Kwee RM. Chest CT imaging signature of coronavirus disease 2019 infection: in pursuit of the scientific evidence. Chest. 2020 158:(5):1885–95. doi: 10.1016/j.chest.2020.06.025.
    [Google Scholar]
  23. Zhang H, Zhou P, Wei Y, et al. Histopathologic changes and SARS-CoV-2 immunostaining in the lung of a patient with COVID-19. Ann Intern Med. 2020 172:(9):629–32. doi: 10.7326/M20-0533..
    [Google Scholar]
  24. Marchiori E, Nobre LF, Hochhegger B, Zanetti G. The reversed halo sign: Considerations in the context of the COVID-19 pandemic. Thromb Res. 2020;: 195:228–30. doi: 10.1016/j.thromres.2020.08.001. Epub 2020 Aug 3. PMID: 32799128; PMCID: PMC7397932.
    [Google Scholar]
  25. Poerio A, Sartoni M, Lazzari G, Valli M, Morsiani M, Zompatori M. Halo, reversed halo, or both? Atypical computed tomography manifestations of coronavirus disease (COVID-19) pneumonia: The “double halo sign”. Korean J Radiol. 2020 21:(10):1161–4. doi: 10.3348/kjr.2020.0687.
    [Google Scholar]
  26. Marchiori E, Penha D, Nobre LF, Hochhegger B, Zanetti G. Differences and similarities between the double halo sign, the chest CT target sign and the reversed halo sign in patients with COVID-19 pneumonia. Korean J Radiol. 2021 22:(4):672–6. doi: 10.3348/kjr.2020.1150..
    [Google Scholar]
  27. Farias LPG, Strabelli DG, Teles GBDS. COVID-19 pneumonia and target sign. Einstein (Sao Paulo). 2021;:19:eAI6564. doi: 10.31744/einstein_journal/2021AI6564..
    [Google Scholar]
  28. Wu J, Tang J, Zhang T, Chen YC, Du C. Follow-up CT of “reversed halo sign” in SARS-CoV-2 delta VOC pneumonia: A report of two cases. J Med Virol. 2022 94:(4):1289–91. doi: 10.1002/jmv.27533..
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2022.ismc.9
Loading
/content/journals/10.5339/jemtac.2022.ismc.9
Loading

Data & Media loading...

  • Article Type: Research Article
Keyword(s): bullseye signCOVID-19 pneumonia and reversed halo sign
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error