High altitude pulmonary edema

High altitude
pulmonary edema (HAPE) in a Himalayan trekker: a case report. Initial Chest x-ray showing pulmonary infiltrates in the right lung especially in the right mid and lower lung zones indicative of pulmonary edema.
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Clinical
characteristics of venous thromboembolism onset from severe high altitude pulmonary edema in plateau regions. High altitude pulmonary edema (HAPE) in a 39-year-old boy who had dyspnea at rest and worsening cough for 3 days before admission. A-D Axial image of CT pulmonary angiogram showing thrombi as filling defects in right main pulmonary artery extending into its branch and in distal left pulmonary artery with extension into its superior branch. E-H Multiple lesions of ground glass opacity, patchy lesions and partial consolidation in the CT imaging were presented in the bilateral lung center along the bronchovascular bundle
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High altitude pulmonary edema is a subtype of pulmonary edema and is caused by prolonged exposure to an environment with a lower partial oxygen atmospheric pressure.

Epidemiology

It occurs most frequently in young males and ~24-48 hours after they have made a rapid ascent to heights greater than 2,500-3,000 meters and have remained in that environment.

Clinical presentation

Reported clinical manifestations include:

  • dyspnea at rest
  • cough with frothy pink sputum production
  • neurological disturbances associated with concomitant brain edema

Pathology

The pathogenesis is considered to be from the altered permeability of the alveolar-capillary barrier secondary to intense pulmonary vasoconstriction and high capillary pressure .

This, in turn, induces endothelial leakage, which results in interstitial and alveolar edema without diffuse alveolar damage.

Radiographic features

Plain radiograph

Chest radiographic features can vary with the degree of hypoxemia.

Central interstitial edema with peribronchial cuffing, ill-defined vessels, and a patchy, frequently asymmetric pattern of airspace consolidation is usually seen. A few Kerley lines may also be visible.

In mild high-altitude pulmonary edema, consolidation may be subtle or absent with little or no involvement of the lung periphery. In severe cases, there may be a tendency to form more confluent changes which can eventually involve the entire lung parenchyma.

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Assoziationen und Differentialdiagnosen zu Höhenlungenödem:
Lungenödem
 
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Kerley-Linien
 
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