“Butterfly-like” shadow refers to the X-ray chest film shows two lungs texture thickening fuzzy, centered on the hilar butterfly-like shadow; CT shows: the upper lobe of the two lungs have chain-like high-density shadow, the remaining lung texture is slightly thickened, and the rest of the CT shows that there are qualitative changes at the end of everything. It is pulmonary malaria disease to the clinical manifestations. Pulmonary malaria disease is the damage to the lungs caused by Plasmodium vivax. The organism is infected by malaria parasite may or may not have typical malaria systemic symptoms at the same time appear obvious respiratory symptoms, such as coughing, coughing sputum, shortness of breath, wheezing or chest pain. Clinical manifestations include malarial asthma, bronchitis, pneumonia, pulmonary edema, and acute respiratory distress syndrome (ARDS). Pulmonary malaria is the pulmonary manifestation of systemic damage of Plasmodium, and its incubation period is comparable to the onset of malaria infection, with 10-20 days for Plasmodium vivax and Plasmodium ovale, 70-80 days for Plasmodium triple day malaria, and 10-14 days for Plasmodium falciparum. What are the examination methods for pulmonary malaria? 1, Peripheral blood, bone marrow or sputum smear Giemsa or Wright staining to find malaria parasites to confirm the diagnosis. Multiple episodes of patients with routine blood erythrocytes and hemoglobin decreased. Reticulocytes are increased. Total leukocyte count was normal or low, monocytosis, and eosinophils in the normal range. Some scholars suggest that the peripheral blood image of the total number of leukocytes is reduced, monocytes greater than 15%, combined with the history should be considered malaria may be. 2.Serologic examination. There are indirect immunofluorescence antibody test, indirect red blood cell coagulation test, radioimmunoassay and enzyme-linked immunosorbent assay. For patients with very low density of malaria parasites in blood, it is not easy to find malaria parasites by general methods, which has auxiliary diagnostic significance. 3.Molecular biology method: DNA probe technology is a fast 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. 4.Asthma type X-ray chest radiograph shows signs of lung hyperinflation of varying degrees. 5, Bronchitis type X-ray chest film often shows lung texture enhancement, there are reports of the appearance of this sign up to 60%, some may also have a small piece of shadow along the direction of the lung texture. Pneumonia-type X-ray chest film shows speckles or small pieces of shadows along the lung veins similar to bronchial pneumonia, or segmental or lobar shadows with unclear edges, which may be multiple or single, and are more common in the lower field. This type is easy to be misdiagnosed as bacterial pneumonia, but anti-inflammatory treatment is ineffective, and there is a significant improvement in clinical symptoms and X-ray chest film after 2-3 days of anti-malarial treatment. 7.Pulmonary edema type X-ray chest film shows thickening and blurring of the texture of both lungs, butterfly-like shadow centered on the lung gate, and asymmetric large patchy shadows in the middle and lower fields of both lungs which can be changed according to the different positions of the body.