【原】肺CT反晕征：结合临床破解奇怪的反晕征

很久以前就想写这篇文章了。可惜，一直没有时间来整理这些英文文献。明日复明日，明日何其多。

反晕征，好像也叫仙女岛征，就是晕征反过来。我觉得叫银河系，更像。

遇到反晕征怎么办？我觉得这样就so easy了！

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第一步：用英语问病人“where are you from”

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假如病人说：I am from 拉丁beautiful洲，那么，很可能是巴西等地特有的paracoccidioidomycosis（副球孢子菌病）。

假如病人一脸茫然的瞅着你，OK，中国没有这个病，去过拉丁美洲的中国人除外。

第二步：问病人do you have糖尿病？

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yes。糖尿病的患者有反晕征，高度警惕肺毛霉菌病（pulmonary mucormycosis）。

第三步：问病人do you have 白血病？

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假如病人有白血病，或者化疗等，导致抵抗力下降，那么，很可能是肺毛霉菌病（pulmonary mucormycosis），两性霉素B、泊沙康唑可以考虑启动了。

第四步：继续问病史、完善常规检查

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1.28岁，发热，咳嗽，胸痛，血肌酐升高，尿蛋白阳性，尿红细胞阳性。轻度贫血。

肺CT这么奇怪，什么病？

不要管，多系统受损，血管炎。

一查ANCA，阳性。

2.青年女性，单侧下肢水肿，呼吸困难。

A 24-year-old female patient was admitted with symptoms of right lower limb swelling, shortness of breath and dry cough of 1 week duration. There was no history of fever, chest pain, oral contraceptive use, smoking or underlying malignancy. On examin- ation, heart rate was 100 beats per minute, respira-tory rate was 24 breaths per minute while other vital signs and systemic examinations were normal except for swelling in the right lower limb.

肺CT反晕征很奇怪？

单侧下肢水肿，呼吸困难，很明显，肺栓塞了。

3.病人肺CT很奇怪。

不急，查ANA谱！

结果：干燥综合征肺损害。

4.A 59-year-old man presented with a 4-month history of a nonproductive cough and a weight loss of 5kg .

 The level of serum lactate dehydrogenase (LDH) was elevated at 712U/L (normal range 110–240U/L).

说人话：病人干咳，体重下降5kg，LDH明显升高。

结果：淋巴瘤。

5.A 43-year-old man was transferred to our hospital because of persistent

pyrexia, chest pain with multiple cavitary lung lesions for a month.

病人发热、胸痛。

不着急，做个心脏彩超，血培养，结果：心内膜炎。

诊断：耐甲氧西林金葡菌肺炎。

6.病人野外游泳，呼吸困难，肝脾肿大，血嗜酸细胞增高。

肝脾肿大，血嗜酸细胞增高，结果：肺血吸虫感染。

第五步：最后再仔细看CT，分析反晕征的特点

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小结节集合形成的反晕征：肺结核。

反晕征沿着支气管血管束分布：肺结核。

反晕征在尖后段、背段：肺结核？

第六步：剩下的，一般是间质性肺病

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间质性肺病，形成反晕征常见的是：隐源性机化性肺炎，结节病，嗜酸细胞性肺病，过敏性肺炎等。

今天先说一个隐源性机化性肺炎，因为反晕征一开始就是在隐源性机化性肺炎中发现，刚开始以为是隐源性机化性肺炎的特征，后来发现，很多病都会反晕征！

我晕。

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参考文献：

1. Maimon N . A 47-year-old female with shortness of breath and "reversed halo sign".[J]. European Respiratory Review An Official Journal of the European Respiratory Society, 2010, 19(115):83-5.

2. Marchiori E , Zanetti G , Godoy M C . Can morphologic characteristics of the reversed halo sign narrow the differential diagnosis of pulmonary infections?[J]. Ajr American Journal of Roentgenology, 2014, 203(5):557-8.

3. Menna B M , Marchiori E , De B A , et al. CT morphological features of the reversed halo sign in pulmonary paracoccidioidomycosis.[J]. British Journal of Radiology, 2015, 88(1055):20150246.

4. Peng M , Shi J , Liu H , et al. Intravascular Large B Cell Lymphoma as a Rare Cause of Reversed Halo Sign: A Case Report.[J]. Medicine, 2016, 95(12):e3138.

5. Okubo Y , Ishiwatari T , Izumi H , et al. Pathophysiological implication of reversed CT halo sign in invasive pulmonary mucormycosis: a rare case report[J]. Diagnostic Pathology, 2013, 8(1):82-82.

6. Nattusamy L , Madan K , Khilnani G C , et al. Pulmonary infarction in acute pulmonary embolism: reversed halo sign.[J]. Bmj Case Reports, 2014, 2014(jun23 1).

7. Madan K, Guleria R. Reverse halo sign[J]. Lung India, 2013, 30(1):72-73.

8. Reverse halo sign in pulmonary  mucormycosis

9. Nitesh Gupta 1 , Raj Kumar 1 and Rajendra Prasad 2. Reversed Halo Sign.Indian J Chest Dis Allied Sci 2014;56:247-248.

10. M.A. Duarte-Millán, Bernal-Bello D , Rueda-Camino J A , et al. Reversed halo sign as initial manifestation of interstitial pneumonitis associated with Sjögren’s syndrome[J]. Egyptian Rheumatologist, 2016, 39(3).

11. Reversed halo sign caused by huge tricuspid native valve infective endocarditis associated with community-acquired methicillin-resistant

      Staphylococcus aureus

12.Loganathan Nattusamy, 1 Karan Madan, 1 Ashu S Bhalla, 2 Randeep Guleria .Reversed halo sign in         active pulmonary tuberculosis.Nattusamy L, et al. BMJ Case Rep 2014. doi:10.1136/bcr-2013-            202981

13.Arthur Soares Souza Jr. 1 , Antonio Soares Souza 2 . Reversed halo sign in acute schistosomiasis. J         Bras Pneumol. 2015;41(3):286-288

14.Another cause of reverse halo sign: Wegener’s granulomatosis

大理，无量山，樱花谷。