Imaging Case of the Week 499 Answer

The frontal chest x-ray shows

Bilateral ground glass opacity in the shape of a bat’s wing.

In a patient presenting with haemoptysis, the appearance likely indicates alveolar haemorrhage.

Diffuse alveolar haemorrhage (DAH) is a medical emergency as it can lead to respiratory failure. Causes of DAH are –

  • Systemic vasculitis (GPA, Goodpasture’s disease, SLE).
  • ARDS due to any cause.
  • Medications – anticoagulants, Glycoprotein IIB IIIA inhibitors.
  • HIV with Kaposi sarcoma
  • Crack cocaine inhalation.

The above patient was stable, was admitted and underwent supportive treatment. Likely cause for their presentation was cocaine snorting. A chest x-ray repeated after 3 days showed complete resolution of the ground glass pattern seen initially.

Further reading