There are mainly two causes why not to demonstrate a halo sign
on ultrasound. Firstly, the echostructure of the nodule may be
identical with that of the capsule. This was the situation in the cases
presented in the first 5 image pairs. Secondly, the capsule may be
comprised and therefore we cannot find it on ultrasound. (See sixth
image-pair.) In these situations the presence of a capsule may be
evaluated by Doppler mode i.e. by the demonstration of vessels running
in the capsule. There is a third possibility when a halo sign cannot be
displayed, in the event of the so-called eggshell calcification. See
next Table.