The plain chest radiograph and clinical management of pulmonary edema in pregnancy

OBJECTIVE: To evaluate the reproducibility of radiographic quantification of pulmonary edema on the supine plain chest radiograph and to correlate the radiographic appearance of edema with the clinical assessment and treatment of pulmonary edema. STUDY DESIGN: Retrospective, blind, descriptive study of 24 women with singleton pregnancies in the last trimester selected because of a clinical question of pulmonary edema. RESULTS: Interobserver variability between radiologists resulted in an average weighted κ of .71 in grading edema on a 0-3 scale where 0 = no edema and 3 = alveolar flooding. The vascular pedicle (a measure of central circulating volume) was larger among patients who received furosemide (63.4 mm) than those who did not (57.0 mm) (P = .01). The vascular pedicle was also larger among patients receiving tocolytics or steroids (62.8 mm) than those who did not (56.0 mm) (P = .01). The radiographic edema score tended to be lower in patients who received tocolytics and steroids (P = .05). The other correlations were not significant. CONCLUSION: Radiographic assessment of pulmonary edema shows fair to good reproducibility, 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 the clinical course and treatment of these patients.