Reversed halo sign as initial manifestation of interstitial pneumonitis associated with Sjögren’s syndrome

Introduction: Sjögren’s syndrome (SS) is a chronic autoimmune multisystemic disease. Respiratory manifestations of SS are polymorphic and vary in severity. Among the possible manifestations, organizing pneumonia (OP) is a rare entity. Reversed halo sign (RHS) is an unusual radiological finding classically related to OP but it is also reported in other forms of interstitial pneumonitis (IP). Case presentation: We report a case of a 65-year-old woman with dyspnoea and persistent-cough of 2-month duration. She presented with RHS as an initial manifestation of IP related to SS. Chest radiography and computer tomography showed multiple well defined lesions with a central ground glass area and peripheral rim of consolidation. No pathological lymph nodes were found. After investigations, the associated diagnosis of SS was confirmed. The patient started steroids (0.5 mg/kg/day) and after 10 weeks of steroid tapering a significant clinical improvement was observed, with radiological resolution of lung lesions. We make some general considerations about differential diagnosis, conditions related to RHS and different patterns of lung involvement in SS. A report of the literature emphasizes this case as an exceptional way of presentation. Conclusion: To the best of our knowledge this is the second reported OP case associated with SS manifesting as RHS. RSH as an expression of IP related to SS is exceptional, either in the pattern of OP or non-specific IP

Comparison of Lung Ultrasound versus Chest X-ray for Detection of Pulmonary Infiltrates in COVID-19

Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR