The bat-wing radiographic pattern is classically linked to which disease?

• A. Bronchiectasis
• B. IPF
• C. Asbestosis
• D. Sarcoidosis

Answer: (D)

The bat-wing pattern reflects central, perihilar lung involvement that creates wing-like opacities on a frontal chest radiograph. In sarcoidosis, granulomatous inflammation around the perihilar regions, often with bilateral hilar lymphadenopathy, produces symmetric reticulonodular opacities centered around the hila that can extend outward, giving that butterfly or bat-wing appearance. This central, perihilar distribution is characteristic of sarcoidosis on radiographs, especially in the stages where hilar adenopathy accompanies interstitial involvement.

Other conditions tend to show different distributions: edema typically shows vascular congestion and may include cardiomegaly and effusions; bronchiectasis shows airway-dominant markings with tram-track patterns; IPF presents with subpleural, basilar-p predominant reticulation and honeycombing; asbestosis mainly shows lower-lobe predominant fibrosis with pleural plaques. Thus, the central, wing-shaped opacities described here are best linked to sarcoidosis.