High-Altitude Pulmonary Edema Workup

  • Author: Rohit Goyal, MD; Chief Editor: Zab Mosenifar, MD   more...
 
Updated: Jan 18, 2012
 

Laboratory Studies

  • Findings on laboratory studies from high-altitude pulmonary edema (HAPE) patients are nonspecific.
  • Arterial blood gas measurement may show acute respiratory alkalosis. A mild leukocytosis also may be present.
  • Some studies have demonstrated increase in interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1ra), and cross-reacting protein (CRP) in response to high altitude. The systemic increase of these inflammatory markers may reflect considerable local inflammation.[5]
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Imaging Studies

  • Chest radiography in high-altitude pulmonary edema (HAPE) patients reveals bilateral patchy infiltrates.
  • In one study, stress echocardiography was used to quantitate pulmonary artery systolic pressure responses to prolonged hypoxia and normoxic exercise.[6] The data from the study indicate that individuals who are susceptible to HAPE have abnormal vascular responses not only to hypoxia but also to supine bicycle exercise under normoxic conditions. Thus, this modality may be a useful noninvasive screening method to identify subjects susceptible to HAPE.
  • Chest ultrasonography was evaluated in one study and showed that the comet-tail technique, which has been shown in cardiogenic pulmonary edema, effectively recognizes and evaluates the degree of pulmonary edema in HAPE patients.[7]
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Other Tests

  • ECG in high-altitude pulmonary edema (HAPE) patients may reveal a right-sided heart strain pattern suggestive of pulmonary hypertension.
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Procedures

  • Portable hyperbaric chambers (Gamow, CERTEC) are in wide use by trekkers. A physiologic (simulated) descent of approximately 2000 m may be achieved in a few minutes. Patients are typically treated in 1-hour increments. Patients should be closely observed for rebound symptoms after hyperbaric treatments.
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Contributor Information and Disclosures
Author

Rohit Goyal, MD  Fellow, Division of Pulmonary Medicine, Lenox Hill Hospital, New York University School of Medicine

Rohit Goyal, MD is a member of the following medical societies: American College of Chest Physicians, American Medical Association, and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Mir Omar Ali, MD  Fellow, Department of Pulmonary Medicine, Lenox Hill Hospital, New York University

Mir Omar Ali, MD is a member of the following medical societies: American College of Physicians and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Samia Qazi, MD  Director of the Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, State University of New York Health Science Center at Stony Brook

Samia Qazi, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Laurie Ward, MD  Chief, Co-Director of Travel and Immunization Clinic, Nassau County Medical Center; Assistant Professor, Department of Internal Medicine, Division of Primary Care, State University of New York at Stony Brook

Laurie Ward, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, International Society of Nephrology, and National Kidney Foundation

Disclosure: Nothing to disclose.

Qazi Qaisar Afzal, MD  Clinical Instructor, Department of Medicine, State University of New York at Stony Brook

Qazi Qaisar Afzal, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Mir Mustafa Ali  Deccan College of Medical Sciences, Owaisi Hospital and Research Center, Princess Esra Hospital, India

Disclosure: Nothing to disclose.

Klaus-Dieter Lessnau, MD, FCCP  Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory; Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital

Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory Tino, MD  Director of Pulmonary Outpatient Practices, Associate Professor, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Medical Center and Hospital

Gregory Tino, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and American Thoracic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD  Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

References

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