Analysis on the clinical and imaging features of pulmonary embolism with reversed halo sign as the mainCT manifestation
HUANG Shengjing1, ZHOU Changsheng1, ZHANG Lin1, LU Lu1, ZHANG Xiaoyu2.
1.Department of Pulmonary and Critical Care Medicine, the Affiliated Cangnan Hospital of Wenzhou MedicalUniversity, Wenzhou 325800, China; 2.Department of Radiology, the Affiliated Cangnan Hospital of WenzhouMedical University, Wenzhou 325800, China
HUANG Shengjing,ZHOU Changsheng,ZHANG Lin, et al. Analysis on the clinical and imaging features of pulmonary embolism with reversed halo sign as the mainCT manifestation[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2024, 54(2): 146-150，155.
Abstract：Objective: To analyze the clinical and imaging features of pulmonary embolism (PE) with reverse halo sign (RHS) as the main CT manifestation so as to better understand the value of this imaging sign in the early diagnosis of PE. Methods: A total of 15 PE inpatients confirmed by CT pulmonary angiography (CTPA)with RHS as the main CT manifestation were collected from the Affiliated Cangnan Hospital of Wenzhou Medical University from January 2016 to April 2023, whose imaging and clinical data were retrospectively analyzed and summarized. Results: Among the 15 PE patients with RHS as the main CT manifestation, the main clinical symptoms were chest pain and dyspnea, but more than half of the patients were complicated by fever, cough and sputum with elevated white blood cells and CRP, in which 11 patients were misdiagnosed as pneumonia and given anti-infection treatment. The results of imaging analysis showed that there were 16 RHS lesions in 15 patients,of which 14 patients had single lesions and 1 patient had 2 RHS lesions. All RHS lesions were located under the pleura of the lower lung, with 10 in the right lower lung and 6 in the left lower lung. RHS lesions were mostly oval (12/16), wedge-shaped (2/16) and hump-like changes (2/16), the long axis of the lesions parallel to the
pleura. The RHS center showed low-density with ground-glass shadow surrounded by a solid ring with a polished border; meanwhile,11 patients had a small amount of pleural effusion. After more than 3 months of standardized anticoagulation treatment, all RHS lesions were absorbed, a few changed to linear scar, and pleural effusiondisappeared. Conclusion: Most RHS lesions in PE patients are located under the pleura, especially common on the lower lung field, mainly single-lesion, oval in shape with the long axis parallel to the pleura and often at the same time combined with a small amount of pleural effusion. PE patients with RHS as the main CT manifestation are prone to the misdiagnosis of pneumonia. It should be vigilant for the possibility of PE in patients with the above imaging features.
