Halo sign in IPA

Date: 26 November 2013

  • 1ipa15

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Halo sign in IPA

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Notes:

CT scan of a neutropenia patient with leukaemia who has 2 lesions. One, on the right, is nodular, abuts on the pleura and is surrounded by a (grey) low attenuation area, referred to as the “halo” sign. This is virtually only seen in invasive fungal infections of the lung, especially early in the course of the disease, during neutropenia. The other lesion visible on this scan, posteriorly on the left, is also typical of invasive pulmonary aspergillosis in that it is pleura-based and has sharply angulated sides typical of vascular invasion and infarction of small lung segments. There is the suggestion of a “halo” sign anteriorly, but there is less confidence in this appearance (compared with the other) because it is only on one side of the lesion.

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  • abpa11

  • abpa10

  • Bronchocentric granulomatosis

    Further details

    Image G. Patient was a 9 year old girl 5 months post matched unrelated donor (MUD) bone marrow transplantation with T-cell depletion, with reduced respiratory function (dyspnoea), cough and crackles at the bases, without fever. Donor and recipient were CMV antibody negative. 5/10/98.  

    Image A. Lung biopsy - H&E section of right lung showing a large granuloma with some central necrosis, consistent with tuberculosis or an invasive fungal infection. Special stains for acid fast organisms and fungi were negative. - 3/11/98, Image B. Lung biopsy - High power H&E stained section of right lung showing a group of giant cells surrounded by lymphocytes. - 3/11/98 , Image C. Lung biopsy - Low power H&E stained section of right lung showing preservation of a small artery, but destruction of a small bronchus by a granulomatous process. - 3/11/98 , Image D. Lung biopsy - Low power elastin stain of right lung showing preservation of the normal elastin fibres around a small artery, but loss of elastin around a small bronchus, indicating bronchial destruction. - 3/11/98 - , Image E. Chest X-ray showing progression of infiltrates, despite azithomycin and itraconazole. She subsequently responded to large doses of corticosteroids. 3/11/98 , Image F. CT scan showing multiple small nodules of variable size in both lung fields, apparently close to the vascular bundles. 6/10/98 , Image G. Chest X-ray showing bilateral diffuse infiltrates consistent with a miliary disease such as tuberculosis or aspergillosis. 5/10/98.

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  • A. fumigatus stained with Blankophor®

    A needle biopsy of a solitary round infiltrate found near the thoracic wall in a patient with acute lymphoblastic leukaemia was gram-stained and then treated with an alkaline solution of the whitening agent Blankophor®.

    patt20

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  • Pulmonary aspergillosis

    Medium power view (H&E) of lung tissue in patient with invasive pulmonary aspergillosis in which many of the fungal hyphae are seen in cross section.

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