The “butterfly-like” shadow is a butterfly-like shadow with thickened and blurred texture in both lungs, centered on the hilum, as shown on X-ray chest X-ray. It is the clinical manifestation of pulmonary malaria disease. Pulmonary malaria disease refers to the damage to the lung caused by Plasmodium vivax. After the body is infected by Plasmodium, there may or may not be typical systemic symptoms of malaria and obvious respiratory symptoms, such as cough, sputum, shortness of breath, wheezing or chest pain. The clinical manifestations include malarial asthma, bronchitis, pneumonia, pulmonary edema and acute respiratory distress syndrome (ARDS). The incubation period is comparable to that of malaria, ranging from 10 to 20 days for Plasmodium interval and Plasmodium ovale, 70 to 80 days for Plasmodium trisomy 21, and 10 to 14 days for Plasmodium falciparum. How to check the “butterfly” shadow? The diagnosis is based on ① epidemiological data; ② typical or atypical periodic symptoms of chills, fever, sweating and fever retreat; ③ obvious cough, cough, shortness of breath, asthma and other respiratory symptoms; ④ X-ray chest film shows enhanced lung pattern or lamellar shadow; CT shows: chain-like high-density shadow in the upper lobe of both lungs, the rest of the lung texture is slightly thickened, and the rest of the CT shows all end qualitative changes; ⑤ blood, bone marrow or sputum smear Find Plasmodium; ⑥After anti-malarial treatment, clinical symptoms disappear to diagnose. Laboratory tests 1.Giemsa or Wright staining of peripheral blood, bone marrow or sputum smear to find Plasmodium parasites to confirm the diagnosis. Patients with multiple episodes have a decrease in routine red blood cells and hemoglobin. Reticulocytes are increased. Total leukocyte count is normal or low, monocytes are increased, and eosinophils are in the normal range. Some scholars suggest that a decrease in total leukocytes and monocytes greater than 15% in peripheral blood should be considered as malaria when combined with medical history. 2.Serological tests include indirect immunofluorescence antibody test, indirect red blood cell coagulation test, radioimmunoassay and enzyme-linked immunosorbent assay. For patients with very low density of Plasmodium in blood, it is useful to find Plasmodium by general methods. 3.Molecular biology method DNA probe technology is a quick and specific method to diagnose malaria. The isotope-labeled DNA probe can detect 10pg of purified Plasmodium DNA or very low level of Plasmodium blood. Other auxiliary examinations 1.Asthma type X-ray chest film with varying degrees of lung hyperinflation. Bronchiectasis type X-ray chest film often shows lung texture enhancement, some reports show this sign up to 60%, some may also have a small shadow along the lung lines. 3, pneumonia type X-ray chest radiographs show speckled or small shadows similar to bronchial pneumonia along the lung striae, or segmental or lobar shadows with indistinct margins, which can be multiple or single, more common in the lower field, this type is easily misdiagnosed as bacterial pneumonia, but anti-inflammatory treatment is ineffective, and clinical symptoms and X-ray chest radiographs show significant improvement after 2-3 days of antimalarial treatment. 4, pulmonary edema type X-ray chest film shows two lung texture thickening fuzzy, centered on the lung door butterfly shadow and two lung asymmetrical in the middle and lower fields of the shadow can be changed with different positions and other changes.