No Mutants Allowed

I have no idea about those tanks, so enlighten me maybe.

I see absolutely nothing Patton-based in the double-barreled Heavy Tank from Fallout 4.
Neither the body, turret, threads or even the barrel has anything in common with any Patton model I'm familiar with.

I think the confusion might be because a Patton is depicted in a war mural ingame.

The closest that abomination gets to a real life patton ircc is that it has a 90mm cannon, just two of them for some reason.

I do not know much about the design principles behind real tanks, why they are made as they are now.
But I think Bethesda went with the 'rule of cool' regarding vehicles rather than what is really practical or realistic.