A 49-year-old COPD patient arrives to the ER complaining of shortness of breath (SOB) and difficulty breathing. The physical examination reveals bilateral coarse crackles throughout the lung fields, pedal edema, and hepatomegaly

The chest x-ray shows bilateral fluffy infiltrates with a "bat's wing" configuration. What clinical condition you may suspect on this patient?
a. Acute coronary syndrome
b. COPD exacerbation
c. Hypertensive crisis
d. Left heart failure

ANS: D
The term "bat's wing" appearance is applied to the predominance of edema in the hilar regions of both lungs with progressively less edema in the more peripheral areas of the lungs. Left heart failure and CHF will cause congestion of the pulmonary vessels leading to pulmonary edema throughout the lung fields.