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Reversed halo sign in acute schistosomiasis.

Souza Jr AS, Souza AS, Soares-Souza L, Zanetti G, Marchiori E - J Bras Pneumol (2015 May-Jun)

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil.

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Another HRCT scan, obtained four months after treatment, showed no abnormalities... Schistosomiasis is a major helminthic infection in tropical and subtropical regions; it has affected an estimated 200 million people, resulting in considerable morbidity and occasional mortality... Humans are colonized by three major species of the parasite: S. mansoni, common in Africa, the Middle East, and South America; S. haematobium, common in Africa and the Middle East; and S. japonicum, common in Japan and China... Schistosomiasis progresses through three phases, as defined by the migration of the helminth: allergic (cercarial) dermatitis, which occurs during the penetration of cercariae into the skin; acute schistosomiasis, which occurs during the oviposition phase; and chronic schistosomiasis, caused by the formation of granulomas and fibrosis around the helminth eggs retained in the pulmonary vasculature, which can result in arteriolitis obliterans, pulmonary hypertension, and cor pulmonale... Symptoms and signs can include fever, chills, weakness, weight loss, headache, nausea, vomiting, diarrhea, hepatomegaly, and splenomegaly... The disease is usually self-limited, but severe cases can result in death... The most common CT finding in patients with acute pulmonary schistosomiasis is that of small (2- to 15-mm) pulmonary nodules... Although organizing pneumonia is considered to be the most frequent cause of the reversed halo sign, morphological aspects of the halo, particularly the presence of small nodules in the wall or inside the reversed halo, strongly suggest a diagnosis of active granulomatous disease, especially pulmonary tuberculosis or pulmonary sarcoidosis... In the present case, the reversed halo sign was observed in a patient with acute schistosomiasis... In conclusion, schistosomiasis should be considered in the differential diagnosis of nodular reversed halo sign, particularly in patients with an epidemiological history suggestive of the disease... In the case presented here, the analysis of histological sections demonstrated that the nodules were related to the presence of granulomas.

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HRCT scans showing patchy areas of ground-glass attenuation, small nodules, and nodular reversed halo signs in both lower lobes of the lungs.
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f01: HRCT scans showing patchy areas of ground-glass attenuation, small nodules, and nodular reversed halo signs in both lower lobes of the lungs.

Mentions: A 35-year-old rural worker presented with a 15-day history of progressive dyspnea, which, for the last 5 days, had been accompanied by dry cough, myalgia, asthenia, and fever. The patient also mentioned that he had swum in natural waters within the last 20 days. Physical examination showed mild painful hepatomegaly and splenomegaly. Chest X-rays showed bilateral reticulonodular infiltrates. An HRCT scan revealed patchy areas of ground-glass attenuation, irregular interlobular septal thickening, intralobular interstitial thickening, and small confluent nodules. Nodular reversed halos (focal, rounded areas of ground-glass opacity surrounded by more or less complete rings of consolidation) were also observed in the lower lobes of the lungs (Figure 1).


Reversed halo sign in acute schistosomiasis.

Souza Jr AS, Souza AS, Soares-Souza L, Zanetti G, Marchiori E - J Bras Pneumol (2015 May-Jun)

HRCT scans showing patchy areas of ground-glass attenuation, small nodules, and nodular reversed halo signs in both lower lobes of the lungs.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541767&req=5

f01: HRCT scans showing patchy areas of ground-glass attenuation, small nodules, and nodular reversed halo signs in both lower lobes of the lungs.
Mentions: A 35-year-old rural worker presented with a 15-day history of progressive dyspnea, which, for the last 5 days, had been accompanied by dry cough, myalgia, asthenia, and fever. The patient also mentioned that he had swum in natural waters within the last 20 days. Physical examination showed mild painful hepatomegaly and splenomegaly. Chest X-rays showed bilateral reticulonodular infiltrates. An HRCT scan revealed patchy areas of ground-glass attenuation, irregular interlobular septal thickening, intralobular interstitial thickening, and small confluent nodules. Nodular reversed halos (focal, rounded areas of ground-glass opacity surrounded by more or less complete rings of consolidation) were also observed in the lower lobes of the lungs (Figure 1).

View Article: PubMed Central - PubMed

Affiliation: Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, Brazil.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Another HRCT scan, obtained four months after treatment, showed no abnormalities... Schistosomiasis is a major helminthic infection in tropical and subtropical regions; it has affected an estimated 200 million people, resulting in considerable morbidity and occasional mortality... Humans are colonized by three major species of the parasite: S. mansoni, common in Africa, the Middle East, and South America; S. haematobium, common in Africa and the Middle East; and S. japonicum, common in Japan and China... Schistosomiasis progresses through three phases, as defined by the migration of the helminth: allergic (cercarial) dermatitis, which occurs during the penetration of cercariae into the skin; acute schistosomiasis, which occurs during the oviposition phase; and chronic schistosomiasis, caused by the formation of granulomas and fibrosis around the helminth eggs retained in the pulmonary vasculature, which can result in arteriolitis obliterans, pulmonary hypertension, and cor pulmonale... Symptoms and signs can include fever, chills, weakness, weight loss, headache, nausea, vomiting, diarrhea, hepatomegaly, and splenomegaly... The disease is usually self-limited, but severe cases can result in death... The most common CT finding in patients with acute pulmonary schistosomiasis is that of small (2- to 15-mm) pulmonary nodules... Although organizing pneumonia is considered to be the most frequent cause of the reversed halo sign, morphological aspects of the halo, particularly the presence of small nodules in the wall or inside the reversed halo, strongly suggest a diagnosis of active granulomatous disease, especially pulmonary tuberculosis or pulmonary sarcoidosis... In the present case, the reversed halo sign was observed in a patient with acute schistosomiasis... In conclusion, schistosomiasis should be considered in the differential diagnosis of nodular reversed halo sign, particularly in patients with an epidemiological history suggestive of the disease... In the case presented here, the analysis of histological sections demonstrated that the nodules were related to the presence of granulomas.

Show MeSH
Related in: MedlinePlus