Lung ultrasound and chest x-ray demonstrated moderate agreement (κ = 0.57) and strong positive correlation (ρ = 0.60, p<0.001) in detecting pulmonary edema lateralization in SIPE patients.
Observational (n=82)
Does lung ultrasound show concordance with chest x-ray in detecting pulmonary edema lateralization in maritime trainees with swimming-induced pulmonary edema?
Lung ultrasound demonstrates moderate to strong concordance with chest radiography in detecting pulmonary edema lateralization in patients with swimming-induced pulmonary edema.
Effect estimate: κ = 0.57, ρ = 0.60
p-value: p=<0.001
Abstract Rationale Swimming-induced pulmonary edema (SIPE) is a condition characterized by acute pulmonary symptoms during strenuous water activities, notably affecting military trainees and open-water swimmers. Unilateral pulmonary edema, often on the dependent side during lateral or side-down positions, suggests gravitational and regional perfusion influences. While chest x-ray (CXR) and lung ultrasound (LUS) are utilized for diagnosis, their comparative effectiveness, particularly in detecting lateralization, remains underexplored. The primary aims of this study are to compare CXR and LUS findings in patients with SIPE, determine whether the dependent side in water while performing combat sidestroke (CSS) correlates with unilateral imaging findings, and explore any differences in detection between these modalities. Addressing these objectives may improve diagnostic precision, deepen understanding of SIPE’s underlying mechanisms, and guide more effective management of affected individuals in aquatic and military training environments. Methods A retrospective review of 82 maritime trainees with SIPE which assessed clinical, radiographic, and ultrasound data to confirm pulmonary edema and its laterality. This review also examines the relationship between side-down positioning during sidestroke and imaging abnormalities. Chest radiographs and lung ultrasounds were scored with a 5-point Likert scale for side predilection. Their concordance was analyzed alongside the influence of body position on chest imaging findings. The two Likert scales were compared for association, agreement, and directionality using Chi squared, Cohen’s Kappa, and Spearman’s rank correlation. Results A significant association was observed between CXR and LUS lateralization scores (χ²=21.45, p.001), with moderate agreement (κ = 0.57) and a strong positive correlation (ρ = 0.60). When analyzing the full five-point scale, agreement improved (κ = 0.59, ρ = 0.63) (Table 1). A significant association was seen between lung edema lateralization on imaging and body position (p 0.001). Conclusion This study demonstrates a moderate to strong concordance between chest radiography and lung ultrasound in detecting pulmonary edema lateralization in SIPE patients. Both modalities demonstrate significant correlation between dependent side-down positioning and unilateral edema. The study’s focus on lateralization underscores the importance of positional factors during water activities. Recognizing dependence-related asymmetry in pulmonary edema suggests that positional strategies, such as switching sides during CSS, could help reduce SIPE risk. While LUS is a valuable tool in the evaluation and diagnosis of SIPE, its limitations in identifying or characterizing more centrally located lesions or alternative pathologies should be acknowledged, as these may require complementary imaging modalities for comprehensive assessment. This abstract is funded by: None
Sebreros et al. (Fri,) conducted a observational in Swimming-induced pulmonary edema (SIPE) (n=82). Lung ultrasound (LUS) vs. Chest x-ray (CXR) was evaluated on Concordance between CXR and LUS lateralization scores (κ = 0.57, ρ = 0.60, p=<0.001). Lung ultrasound and chest x-ray demonstrated moderate agreement (κ = 0.57) and strong positive correlation (ρ = 0.60, p<0.001) in detecting pulmonary edema lateralization in SIPE patients.