Multifocal pneumonia can be due to a vast array of organisms, but the bat wing pattern in the immunocompetent patient should suggest particularly aspiration pneumonia, Gram-negative bacterial pneumonia, and nonbacterial pneumonias such as mycoplasmal, viral, and rickettsial pneumonia. 3.33), vasculitis, or neoplasm, particularly lymphangitis carcinomatosa. Cases of bat wing opacities not caused by pulmonary edema are likely to be due to pneumonia, inhalation of noxious gases or liquids (including aspiration of gastric contents), multifocal pulmonary hemorrhage ( Fig. 3.32), particularly if air bronchograms or acinar opacities are present. By far the most common cause is pulmonary edema ( Fig. Bat wing opacities may be symmetric, but are often more severe on one side than the other. The outer portion of each lobe is less involved than the perihilar area and is often normal ( Fig. The opacities consist of coalescent densities with ill-defined borders, sometimes with acinar components at their periphery. The fanciful descriptors for this pattern are an attempt to describe bilateral perihilar opacities.
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