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6 CT Halo Sign

 

 

Fig. 6.3 Hemorrhagic metastasis in a 52-year-old woman with renal cell carcinoma. Lung window of CT (5.0-mm section thickness) scan obtained at level of the interior pulmonary vein shows multiple solid nodules surrounded by ground-glass opacity, suggesting hemorrhagic metastasis

Fig. 6.4 Nodules with halo sign in a 28-year-old man with melanoma. Lung window of CT (5.0-mm section thickness) scan obtained at level of the interior pulmonary vein shows multiple variable-sized nodules (arrows) having surrounding halo (hemorrhagic metastases)

CT–Pathology Comparisons

Symptoms and Signs

A halo of ground-glass opacity surrounding metastatic nodules corresponds to extensive hemorrhage in the nodule and adjacent lung parenchyma. In these conditions, hemorrhage is regarded to be present owing to the fragility of the neovascular tissue with resultant thrombosis and rupture [4].

Pulmonary endometriosis with catamenial hemorrhage is characterized by recurrent hemoptysis occurring within 24Ð48 h after the start of each menstruation cycle in female patients in the reproductive age. Hemoptysis is usually small in amount and lasts a few days. It is frequently accompanied by cough and chest discomfort. The history of the obstetric procedure, especially induced abortion, is common [13].

Patient Prognosis

Advanced stage of the malignancy makes the prognosis very grave.

Pulmonary Endometriosis with Catamenial Hemorrhage

Pathology and Pathogenesis

The heterotopic tissue consists of both stroma and glands and reproduces the appearances of normal endometrium in every way (Fig. 6.5). Decidual change takes place in pregnancy, and cyclic hemorrhagic disruption, with consequent hemosiderosis, may obscure the nature of the tissue, in which case immunocytochemistry may be used to demonstrate estrogen and progesterone receptors and in the stromal component CD10 [12].

CT Findings

During menstruation, focal consolidation with a relatively well-deÞned margin and ground-glass opacity are common CT Þndings of pulmonary parenchymal endometriosis (Fig. 6.5) [3, 4]. However, CT scans obtained after menstruation demonstrate marked improvement of pulmonary consolidation and nodules. Other Þndings of thoracic endometriosis include thin-walled cavities or bullous formation and catamenial hemothorax or pneumothorax.

CT–Pathology Comparisons

CT Þndings of consolidation, nodules, and ground-glass opacity in pulmonary endometriosis can be presumed to represent pulmonary hemorrhage. Hemorrhage could result from the rupture of the capillaries in the endometrial tissue particles trapped within pulmonary vascular network [3, 4].

Pulmonary Endometriosis with Catamenial Hemorrhage

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Patient Prognosis

When the site of pulmonary endometriosis is conÞrmed by chest CT to be localized and Þxed, surgical resection can be tried.

a

b

Medical treatment with progestational agents or gonadotropinreleasing hormones may be applied if hemoptysis continues with conservative therapy. Variable results in terms of shortand long-term outcome have been reported [14].

c

Fig. 6.5 Pulmonary endometriosis showing halo sign in a 46-year-old woman. (a, b) Lung window of consecutive CT scans (2.5-mm section thickness) obtained at levels of liver dome shows a cystic lesion (arrow) of eccentric wall thickness depicting surrounding ground-glass opacity halo in the right lung base. (c) Coronal reformatted (2.0-mm section thickness) image demonstrates cystic lesion with halo sign (arrow). (d)

High-magniÞcation (×100) photomicrograph of pathologic specimen obtained from the right lower lobe with wedge resection by using videoassisted thoracoscopic surgery discloses a nodule composed of many well-formed endometrial glands and admixed stroma. Also note a large dilated gland-forming cyst within central portion of nodule. Inset: stroma is pale pink and is composed of bland-looking oval or spindle cells (×200)