Central Distribution (Bat-Wing)



Central Distribution (Bat-Wing)


Robert B. Carr, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Hydrostatic Pulmonary Edema


  • Pneumonia


Less Common



  • Lung Injury


  • Pulmonary Hemorrhage


Rare but Important



  • Pulmonary Alveolar Proteinosis


  • Acute Interstitial Pneumonia


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Classically described on frontal radiograph, though can be seen on CT


  • Bilateral perihilar opacities with relative sparing of peripheral lung tissue


  • Clinical information is key to diagnosis


Helpful Clues for Common Diagnoses



  • Hydrostatic Pulmonary Edema



    • Usually caused by increased pulmonary venous pressure


    • Most common etiologies include left-sided heart failure and volume overload


    • Interstitial edema: Kerley lines, peribronchial cuffing, perihilar haze


    • Airspace edema: Patchy or diffuse airspace opacities, may present as bat-wing edema


    • Central distribution may be due to rapid onset of edema and better lymphatic clearance of lung periphery


  • Pneumonia



    • Seen with bacterial and atypical pathogens


    • Dense consolidation


    • May see air bronchograms


Helpful Clues for Less Common Diagnoses



  • Lung Injury



    • Caused by illicit drugs (crack cocaine), near drowning, smoke inhalation, sepsis, etc.


    • Disruption of alveolar-capillary interface leads to noncardiogenic pulmonary edema


    • Diffuse alveolar damage


  • Pulmonary Hemorrhage



    • Numerous causes that may present similarly by radiograph


    • Patchy or diffuse ground-glass opacities or consolidation, often with central distribution


    • Can present as ill-defined centrilobular nodules, especially on CT


Helpful Clues for Rare Diagnoses

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Aug 8, 2016 | Posted by in CARDIOLOGY | Comments Off on Central Distribution (Bat-Wing)

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