Elderly patient with know cardiac failure. Acute on chronic shortness of breath. Fluid overload?
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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.
The "bat wing" appearance is used to describe the appearance of perihilar consolidation in the context of pulmonary oedema.
It typically occurs when pulmonary wedge pressures are high. It is one of the core plain radiograph features of cardiac failure.