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The Halo Sign

The Halo Sign Doppler Digest The Journal for Vascular Ultrasound 34(3):143, 2010 Yung-Wei Chi, DO A 72-year-old woman without cardiovascular history presented with bilateral arm weakness. On physical ex- amination she had +3/5 bilateral arm abductor strength and decreased pulses in both radial and ulnar arteries. She denied any history of headache or vision changes. Bilat- eral temporal artery examination was normal. Age- and gender-appropriate cancer screening was unremarkable. Bilateral upper extremity arterial duplex ultrasound examination showed a “halo” sign in both axillary ar- teries (Figure 1). Wrist-to-brachial index showed right arm 0.67 and left arm 0.85 suggested bilateral upper extremity arterial stenosis. Erythrocyte sedimentation rate and C-reactive protein were elevated to 40 and 5.82, respectively. Computed tomographic angiogra- phy of upper extremities indicated bilateral axillary arterial narrowing. The diagnosis of giant cell arteritis Figure 2 After treatment. was made, and the patient was started on prednisone, 40 mg. One month after initiation of medical therapy, her clinical symptoms resolved, and repeat duplex ul- trasound of axillary arteries showed improvement in the “halo” sign (Figure 2). Extracranial giant cell arteritis has been increasingly recognized because of the advances in imaging tech- nologies. The proximal arm arteries are commonly af- fected and, in particular, the axillary arteries are almost always involved. The axillary artery is easily accessi- ble with ultrasound and in giant cell arteritis, a dark hypoechoic, circumferential vessel wall thickening (halo) occurs around the artery lumen. Other ultrasono- graphic fi ndings may include stenosis and/or occlu- sion. In this case, the “halo” sign and clinical symptoms Figure 1 improved with corticosteroid treatment. Before treatment. References From the Section of Vascular Medicine, John Oschner Heart and 1. Schmidt WA, Seifert A, Gromnica-Ihle E, Krause A, Natusch Vascular Institute, Oschner Health System, Metairie, LA. A. Ultrasound of proximal upper extremity arteries to increase the Address correspondence to: Yung-Wei Chi, DO, Section of Vascu- diagnostic yield in large-vessel giant cell arteritis. Rheumatology lar Medicine, John Oschner Heart and Vascular Institute, Oschner (Oxford) 2008;47:96–101. Health System, 2005 Veterans Blvd., Metairie, LA 70002. E-mail: 2. Blockmans D, Bley T, Schmidt W. Imaging for large-vessel ychi@oschner.org vasculitis. Curr Opin Rheumatol 2009;21:19–28. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal for Vascular Ultrasound SAGE

The Halo Sign

Chi, Yung-Wei
Journal for Vascular Ultrasound , Volume 34 (3): 1 – Sep 1, 2010
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References (2)

Publisher
SAGE
Copyright
© 2010 Society for Vascular Ultrasound
ISSN
1544-3167
eISSN
1544-3175
DOI
10.1177/154431671003400307
Publisher site
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Abstract

Doppler Digest The Journal for Vascular Ultrasound 34(3):143, 2010 Yung-Wei Chi, DO A 72-year-old woman without cardiovascular history presented with bilateral arm weakness. On physical ex- amination she had +3/5 bilateral arm abductor strength and decreased pulses in both radial and ulnar arteries. She denied any history of headache or vision changes. Bilat- eral temporal artery examination was normal. Age- and gender-appropriate cancer screening was unremarkable. Bilateral upper extremity arterial duplex ultrasound examination showed a “halo” sign in both axillary ar- teries (Figure 1). Wrist-to-brachial index showed right arm 0.67 and left arm 0.85 suggested bilateral upper extremity arterial stenosis. Erythrocyte sedimentation rate and C-reactive protein were elevated to 40 and 5.82, respectively. Computed tomographic angiogra- phy of upper extremities indicated bilateral axillary arterial narrowing. The diagnosis of giant cell arteritis Figure 2 After treatment. was made, and the patient was started on prednisone, 40 mg. One month after initiation of medical therapy, her clinical symptoms resolved, and repeat duplex ul- trasound of axillary arteries showed improvement in the “halo” sign (Figure 2). Extracranial giant cell arteritis has been increasingly recognized because of the advances in imaging tech- nologies. The proximal arm arteries are commonly af- fected and, in particular, the axillary arteries are almost always involved. The axillary artery is easily accessi- ble with ultrasound and in giant cell arteritis, a dark hypoechoic, circumferential vessel wall thickening (halo) occurs around the artery lumen. Other ultrasono- graphic fi ndings may include stenosis and/or occlu- sion. In this case, the “halo” sign and clinical symptoms Figure 1 improved with corticosteroid treatment. Before treatment. References From the Section of Vascular Medicine, John Oschner Heart and 1. Schmidt WA, Seifert A, Gromnica-Ihle E, Krause A, Natusch Vascular Institute, Oschner Health System, Metairie, LA. A. Ultrasound of proximal upper extremity arteries to increase the Address correspondence to: Yung-Wei Chi, DO, Section of Vascu- diagnostic yield in large-vessel giant cell arteritis. Rheumatology lar Medicine, John Oschner Heart and Vascular Institute, Oschner (Oxford) 2008;47:96–101. Health System, 2005 Veterans Blvd., Metairie, LA 70002. E-mail: 2. Blockmans D, Bley T, Schmidt W. Imaging for large-vessel ychi@oschner.org vasculitis. Curr Opin Rheumatol 2009;21:19–28.

Journal

Journal for Vascular Ultrasound – SAGE

Published: Sep 1, 2010

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