Reversed Halo Sign on CT as a Presentation of Lymphocytic Interstitial Pneumonia

摘要

A 52 year-old African American female with a past medical history of symptomatic uterine fibroids and increasing abdominal circumference underwent abdominal computed tomography (CT) as part of her workup. Because of an abnormality in the left lower lobe, CT of the chest was subsequently performed and showed a focal region of discontinuous crescentic consolidation with central ground glass opacification in the right lower lobe, suggestive of the reversed halo sign. The patient underwent percutaneous CT-guided core biopsy of the lesion, which demonstrated lymphocytic interstitial pneumonia, a benign lymphoproliferative disease characterized histologically by small lymphocytes and plasma cells. This case report describes the first histologically confirmed presentation of lymphocytic interstitial pneumonia with the reversed halo sign on CT. Keywords. Reversed halo sign, Lymphocytic interstitial pneumonia, CTCASE REPORTA 52-year-old African American female with a past medical history significant for symptomatic uterine fibroids presented to the emergency department with menorrhagia and increased abdominal girth. She underwent transvaginal ultrasound (TVUS), which demonstrated a large heterogeneous uterus with areas of calcification, suggestive of uterine fibroids. However, because of the patient’s pelvic pain, rapidly increasing abdominal girth and weight loss, she underwent computed tomography (CT) of the abdomen, which showed incidental small nodules in the left lower lobe [Fig. 1]. A dedicated chest CT was later performed to better characterize the nodules and evaluate for additional pulmonary abnormalities. Open in a separate windowFigure 1 52 year old female with lymphocytic interstitial pneumonia in the right lower lobe. Lung windowed axial Computed Tomography (CT) images of the lung bases on the patient’s presenting CT abdomen/pelvis performed for pelvic pain, increasing abdominal girth and weight loss demonstrate nonspecific subcentimeter non-calcified solid pulmonary nodules in the left lower lobe (green arrows). (Protocol. Phillips Brilliance 64 slice CT scanner, 115 mA, 120 kvp, 3 mm slice thickness, CTDIvol 6.460 mGy, 120 mL Optiray 350 IV contrast at 2 mL/s).