CXR.

The “angel wings” appearance on a chest X-ray (CXR) typically refers to the bilateral lucent areas resembling wings seen in certain neonatal conditions. This finding is most commonly associated with:

1. Pulmonary Alveolar Proteinosis (PAP)

• Caused by abnormal surfactant accumulation, leading to bilateral ground-glass opacities with central sparing and peripheral consolidation.

• The classic “bat wing” or “angel wings” pattern is seen due to alveolar filling, sparing the periphery.

• Can be congenital (mutations in surfactant proteins) or secondary to infections or immune deficiencies.

2. Transient Tachypnea of the Newborn (TTN)

• Mild perihilar streaking and fluid in fissures can sometimes create an “angel wings”-like appearance, though typically less pronounced.

• Caused by delayed clearance of fetal lung fluid, often in infants born via cesarean section.

3. Neonatal Respiratory Distress Syndrome (NRDS/HMD)

• Ground-glass opacities with air bronchograms, sometimes resembling the angel wings pattern.

• Due to surfactant deficiency in preterm infants, leading to alveolar collapse and poor oxygenation.

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