Butterfly and Bat’s Wing Shadow

Herrnheiser and Hinson ¹ (London Chest Hospital) credit Curtis Nessa and Leo Rigler ² with the term ‘butterfly density’ and Hodson’ with the term ‘bat’s wing shadow’ as descriptions of the chest radiographic appearance of pulmonary edema (Figures 1 and 2). These authors may have been the first to put these terms in the printed literature, however, they say in their articles that the ‘classical roentgenologic appearance has been [my italics] described as a butterfly-shaped … density’ ² and that a ‘search in the literature for reference to the ‘bat’swing’ lesion gives disappointing results. It appears to have become accepted as an established abnormality without its natural history and significance being fully defined.’ ³ The latter statement seems to refer to both the term and the disease process. Figure 1 ‘Typical pulmonary edema from cardiac failure. Note the bilateral, symmetrical, butterflyshaped densities with the relatively clear periphery (arrows)’ Reprinted from Nessa and Rigler<xref ref-type="bibr" rid="ref10_2"> ² </xref>. The roentgenological manifestations of pulmonary edema. <italic>Radiology,</italic> 1941, 37, 35–46, with permission of the RSNA https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig10_1_B.jpg"/> Figure 2 ‘After probable attack of left heart failure. Widespread bilateral ‘bat’s wing’ shadows with moderate congestion but no definite basal edema.’ Reprinted from Hodson<xref ref-type="bibr" rid="ref10_3"> ³ </xref>. Pulmonary oedema and the ‘bat’s wing’ shadow./ <italic>Fac. Radiol. (London),</italic> 1950, I, 176–86, with permission of the publisher https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9781003076568/34c29fd5-5662-4e8f-b58c-badd7fa5d724/content/fig10_2_B.jpg"/>