Chest > Diagnosis > Overview of Chest Imaging > Chest Radiographic and CT Signs
Halo Sign
Selected Images
Axial NECT of a patient with
granulomatosis with polyangiitis
shows a nodule with surrounding
ground-glass opacity consistent
with perilesional hemorrhage.
Additional Images
Axial NECT in a patient with
angioinvasive aspergillosis shows 2
solid pulmonary nodules
surrounded by halos of ground-
glass opacity that represent
hemorrhage.
Axial NECT reformation in a patient
with granulomatosis with
polyangiitis shows multifocal
Axial NECT of a patient with acute
myelogenous leukemia shows mass-
like consolidation with surrounding
ground-glass opacity consistent
with hemorrhage surrounding
angioinvasive aspergillosis.
Identification of the CT halo sign in a
neutropenic patient with fever
should always suggest the possibility
of angioinvasive fungal disease.
Axial NECT in a patient with
cytomegalovirus pneumonia post
bilateral lung transplantation shows
a solid left upper lobe nodule
surrounded by extensive ground-
glass opacity. While angioinvasive
aspergillosis has been classically
associated with this appearance,
many other fungal, viral, and
bacterial infections can also produce
the CT halo sign.
Axial NECT of a patient with
metastatic choriocarcinoma shows
ground-glass opacity consistent
with hemorrhage surrounding
multiple nodular pulmonary
metastases.
Axial NECT in a patient with right
atrial angiosarcoma shows small
pulmonary nodules with
surrounding ground-glass opacity
halos. Highly vascular metastases
prone to hemorrhage are often
responsible for this finding (e.g.,
angiosarcoma, choriocarcinoma,
osteosarcoma).
Laura E. Heyneman, MD
Santiago Martínez-Jiménez, MD
Hide Images
Coronal NECT of a patient with
bacterial endocarditis and septic
emboli shows ground-glass opacity
surrounding peripheral soft
tissue nodules . While CT halo
sign often correlates with
hemorrhage (e.g., infarction,
vasculitis, frail neovascular tissue,
necrosis), it can also be associated
with inflammatory or neoplastic
infiltration.
Axial NECT in a patient with
zygomycosis shows that the fungal
infection manifests with a left lower
mass and surrounding ground-glass
opacity.
 bilateral discrete soft tissue lung
nodules, some of which exhibit the
CT halo sign .

KEY FACTS

Terminology
Definition: Pulmonary ground-glass opacity surrounding nodule, mass, or consolidation
Imaging
CT
Soft tissue nodule or mass with variable amount of surrounding ground-glass opacity
Ground-glass opacity optimally evaluated on thin-section CT
MR
T1WI: Peripheral high signal intensity (hemorrhage)
Differentiation from reversed halo sign
Reversed halo sign: Crescentic or ring-like consolidation surrounding ground-glass opacity nodule or mass
Differential diagnosis: Cryptogenic organizing pneumonia, infection, granulomatosis with polyangiitis, pulmonary
infarction, sarcoidosis, radiofrequency ablation
Top Differential Diagnoses
Infection: Angioinvasive fungi (classically Aspergillus, also Candida, Mucor), mycobacteria, rickettsia, viruses (e.g.,Varicella
zoster, Herpes simplex, Cytomegalovirus), and septic embolism
Inflammatory: Granulomatosis with polyangiitis, eosinophilic pneumonia, cryptogenic organizing pneumonia, endometriosis
Neoplastic: Kaposi sarcoma, pulmonary adenocarcinoma with lepidic features, vascular metastases (e.g., angiosarcoma,
choriocarcinoma, osteosarcoma)
Iatrogenic: Posttransbronchial biopsy, catheter-induced pulmonary pseudoaneurysm
Pathology
Ground-glass opacity typically represents hemorrhage but may be due to inflammation or neoplasm
Hemorrhage may be due to hemorrhagic infarction, vasculitis, fragile neovascular tissue, or necrosis

SELECTED REFERENCES

1. Martínez-Jiménez S et al: Imaging features of thoracic metastases from gynecologic neoplasms. Radiographics. 34(6):1742-54, 2014
2. Walker CM et al: Imaging pulmonary infection: classic signs and patterns. AJR Am J Roentgenol. 202(3):479-92, 2014
3. Barreto MM et al: Correlation between computed tomographic and magnetic resonance imaging findings of parenchymal lung
diseases. Eur J Radiol. 82(9):e492-501, 2013
4. Algın O et al: Signs in chest imaging. Diagn Interv Radiol. 17(1):18-29, 2011
5. Walker CM et al: "Reversed halo sign". J Thorac Imaging. 26(3):W80, 2011
6. Marshall GB et al: Signs in thoracic imaging. J Thorac Imaging. 21(1):76-90, 2006
7. Lee YR et al: CT halo sign: the spectrum of pulmonary diseases. Br J Radiol. 78(933):862-5, 2005
8. Pinto PS: The CT Halo Sign. Radiology. 230(1):109-10, 2004
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