Bat wings

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

Elderly patient with know cardiac failure. Acute on chronic shortness of breath. Fluid overload?

Patient Data

Age: 87
Gender: Male
x-ray

Even allowing for the AP projection, the cardiac silhouette is enlarged. Small bilateral pleural effusions.

Bilateral perihilar consolidation/airspace change with a "bat wing" appearance.

Case Discussion

The "bat wing" appearance is used to describe the appearance of perihilar consolidation in the context of pulmonary edema.

It typically occurs when pulmonary wedge pressures are high. It is one of the core plain radiograph features of cardiac failure.

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