Nodular Reverse Halo Sign: An Imaging Feature of Active Pulmonary Tuberculosis

Abstract

A 19-year-old female presented with complaints of cough and fever persisting for one month. The patient also gave a history of loss of appetite and significant weight loss within the same timeframe. There were no complaints of chest pain, breathlessness, or shortness of breath. Upon examination, the patient was febrile with a temperature of 100.4 degrees Fahrenheit and had wheezing with bilateral crepitations on respiratory examination. The rest of the vital parameters and systemic examinations were within normal limits. The High-resolution Computed Tomography (HRCT) of the lungs revealed a Reverse Halo Sign (RHS) with larger nodules peripherally and smaller ones centrally, resembling a Nodular Reverse Halo Sign (NRHS) [Table/Fig-1a-c]. Additionally, thick-walled cavities were observed in the superior segment of the left lower lobe, along with patchy consolidation and bronchiectasis in the left upper lobe [Table/Fig-1a-c]. Centrilobular nodules exhibiting a tree-in-bud appearance were noted in both lungs. These findings were consistent with post-primary pulmonary Tuberculosis (TB), which was confirmed by sputum examination.

Keywords

• consolidation
• centrilobular nodules
• wheezing