THE PLAIN CHEST RADIOGRAPH AND CLINICAL MANAGEMENT OF PULMONARY-EDEMAIN PREGNANCY

OBJECTIVE: To; evaluate the reproducibility of radiographic quantifica tion of pulmonary edema on the supine plain chest radiograph and to co rrelate the radiographic appearance of edema with the clinical assessm ent and treatment of pulmonary edema. STUDY DESIGN: Retrospective, bli nd, descriptive study of 24 women with singleton pregnancies in the la st trimester selected because of a clinical question of pulmonary edem a. RESULTS: Interobserver variability between radiologists resulted in an average weighted kappa of .71 in grading edema on a 0-3 scale wher e 0 = no edema and 3 = alveolar flooding. The vascular pedicle (a meas ure of central circulating volume) was larger among patients who recei ved furosemide (63.4 mm) than those who did not vascular pedicle was a lso larger among patients receiving tocolytics or steroids (62.8 mm) t han those who did not (56.0 mm) (P = .01). The radiographic edema scor e tended to be lower in patients who received tocolytics and steroids (P = .05). The other correlations were not significant. CONCLUSION: Ra diographic assessment of pulmonary edema shows fair to good reproducib ility, but the clinical correlations are modest. A wider understanding of the wealth of physiologic information available on the plain chest radiograph may prove invaluable in understanding standing the clinica l course and treatment of these patients.