title: Diagnosing pulmonary edema: lung ultrasound versus chest radiography.
abstract: BACKGROUND
  Diagnosing the underlying cause of acute dyspnea can be challenging. Lung ultrasound may help to identify pulmonary edema as a possible cause.
  
  
  OBJECTIVE
  To evaluate the ability of residents to recognize pulmonary edema on lung ultrasound using chest radiographs as a comparison standard.
  
  
  METHODS
  This is a prospective, blinded, observational study of a convenience sample of resident physicians in the Departments of Emergency Medicine (EM), Internal Medicine (IM), and Radiology. Residents were given a tutorial on interpreting pulmonary edema on both chest radiograph and lung ultrasound. They were then shown both ultrasounds and chest radiographs from 20 patients who had presented to the emergency department with dyspnea, 10 with a primary diagnosis of pulmonary edema, and 10 with alternative diagnoses. Cohen's κ values were calculated to describe the strength of the correlation between resident and gold standard interpretations.
  
  
  RESULTS
  Participants included 20 EM, 20 IM, and 20 Radiology residents. The overall agreement with gold standard interpretation of pulmonary edema on lung ultrasound (74%, κ = 0.51, 95% confidence interval 0.46-0.55) was superior to chest radiographs (58%, κ = 0.25, 95% confidence interval 0.20-0.30) (P < 0.0001). EM residents interpreted lung ultrasounds more accurately than IM residents. Radiology residents interpreted chest radiographs more accurately than did EM and IM residents.
  
  
  CONCLUSIONS
  Residents were able to more accurately identify pulmonary edema with lung ultrasound than with chest radiograph. Physicians with minimal exposure to lung ultrasound may be able to correctly recognize pulmonary edema on lung ultrasound.
authors.affiliation: Kings County/SUNY Downstate, Brooklyn, New York 11203, USA. martindale.jen@gmail.com
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Martindale
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
authors.forename: Andrew
authors.initials: A
authors.lastname: Liteplo
mesh_terms: D002983:Clinical Competence; D003937:Diagnosis, Differential; D004311:Double-Blind Method; D004417:Dyspnea / Q000209:etiology*; D004635:Emergency Medicine / Q000193:education; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000150:complications / Q000000981:diagnostic imaging*; D011859:Radiography; D011871:Radiology / Q000193:education; D014463:Ultrasonography; D014481:United States