Altitude Illness - Pulmonary Syndromes Differential Diagnoses

  • Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Nov 23, 2011
 
 
 
Contributor Information and Disclosures
Author

N Stuart Harris, MD, MFA, FACEP  Chief, Division of Wilderness Medicine, Massachusetts General Hospital (MGH) Fellowship Director, MGH Wilderness Medicine Fellowship. Attending Physician, MGH Assistant Professor in Surgery, Harvard Medical School

N Stuart Harris, MD, MFA, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, International Society for Mountain Medicine, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Sara W Nelson, MD  Staff Physician, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital and Massachusetts General Hospital

Sara W Nelson, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

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

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Thomas E Dietz, MD, to the development and writing of this article.

References
  1. Richalet JP, Larmignat P, Poitrine E, Letournel M, Canouï-Poitrine F. Physiological Risk Factors of Severe High Altitude Illness: A Prospective Cohort Study. Am J Respir Crit Care Med. Oct 27 2011;[Medline].

  2. Rodway GW, McIntosh SE, Dow J. Mountain research and rescue on Denali: a short history from the 1980s to the present. High Alt Med Biol. Fall 2011;12(3):277-83. [Medline].

  3. Newcomb L, Sherpa C, Nickol A, Windsor J. A comparison of the incidence and understanding of altitude illness between porters and trekkers in the Solu Khumbu Region of Nepal. Wilderness Environ Med. Sep 2011;22(3):197-201. [Medline].

  4. Anderson PJ, Miller AD, O'Malley KA, Ceridon ML, Beck KC, Wood CM, et al. Incidence and Symptoms of High Altitude Illness in South Pole Workers: Antarctic Study of Altitude Physiology (ASAP). Clin Med Insights Circ Respir Pulm Med. 2011;5:27-35. [Medline]. [Full Text].

  5. Fagenholz PJ, Gutman JA, Murray AF, et al. Chest ultrasonography for the diagnosis and monitoring of high-altitude pulmonary edema. Chest. Apr 2007;131(4):1013-8. [Medline].

  6. Bartsch P, Maggiorini M, Ritter M, et al. Prevention of high-altitude pulmonary edema by nifedipine. N Engl J Med. Oct 31 1991;325(18):1284-9. [Medline].

  7. Bartsch P, Mairbaurl H, Maggiorini M, et al. Physiological aspects of high-altitude pulmonary edema. J Appl Physiol. Mar 2005;98(3):1101-10. [Medline].

  8. Clarenbach CF, Christ AL, Senn O, et al. Dexamethasone and tadalafil prevent HAPE and subclinical alterations in lung function and nocturnal oxygenation associated with pulmonary interstitial fluid accumulation. High Alt Med Biol. 2004;4:478.

  9. Das BB, Wolfe RR, Chan KC, et al. High-altitude pulmonary edema in children with underlying cardiopulmonary disorders and pulmonary hypertension living at altitude. Arch Pediatr Adolesc Med. Dec 2004;158(12):1170-6. [Medline].

  10. Durmowicz AG. Pulmonary edema in 6 children with Down syndrome during travel to moderate altitudes. Pediatrics. Aug 2001;108(2):443-7. [Medline].

  11. Fagenholz PJ, Gutman JA, Murray AF, et al. Evidence for increased intracranial pressure in high altitude pulmonary edema. High Alt Med Biol. Winter 2007;8(4):331-6. [Medline].

  12. Fagenholz PJ, Gutman JA, Murray AF, et al. Treatment of high altitude pulmonary edema at 4240 m in Nepal. High Alt Med Biol. Summer 2007;8(2):139-46. [Medline].

  13. Hackett PH. High-altitude medicine. In: Auerbach PS, ed. Wilderness Medicine. 4th ed. St. Louis, Mo: Mosby; 2001:2-43.

  14. Hackett PH, Oelz O. The Lake Louise consensus on the definition and quantification of altitude illness. In: Sutton J, Coates G, Houston C, eds. Hypoxia and Mountain Medicine. 1992:327-30.

  15. Hackett PH, Roach RC. High altitude cerebral edema. High Alt Med Biol. Summer 2004;5(2):136-46. [Medline].

  16. Hackett PH, Roach RC. High-altitude illness. N Engl J Med. Jul 12 2001;345(2):107-14. [Medline].

  17. Harris NS, Stephen TH, Hackett P. International high altitude pulmonary edema registry: research tools for the new millinneum. High Alt Med Biol. 2004;5(2):221.

  18. Houston CS. Acute pulmonary edema of high altitude. N Engl J Med. Sep 8 1960;263:478-80. [Medline].

  19. Hultgren HN. High-altitude pulmonary edema: current concepts. Annu Rev Med. 1996;47:267-84. [Medline].

  20. Jean D, Leal C, Kriemler S, et al. Medical recommendations for women going to altitude. High Alt Med Biol. 2005;6(1):22-31. [Medline].

  21. MacInnis MJ, Koehle MS, Rupert JL. Evidence for a genetic basis for altitude illness: 2010 update. High Alt Med Biol. Winter 2010;11(4):349-68. [Medline].

  22. Maggiorini M, Brunner-La Rocca H-P, Bihm T, et al. Phosphodiesterase-5 inhibition and glucocorticoids prevent excessive hypoxic pulmonary vasoconstriction and high altitude pulmonary edema in susceptible subjects. High Alt Med Biol. 2004;4:494.

  23. [Best Evidence] Maggiorini M, Brunner-La Rocca HP, Peth S, Fischler M, Böhm T, Bernheim A, et al. Both tadalafil and dexamethasone may reduce the incidence of high-altitude pulmonary edema: a randomized trial. Ann Intern Med. Oct 3 2006;145(7):497-506. [Medline].

  24. Nakagawa S, Kubo K, Koizumi T, et al. High-altitude pulmonary edema with pulmonary thromboembolism. Chest. Mar 1993;103(3):948-50. [Medline].

  25. Oelz O, Maggiorini M, Ritter M, et al. Prevention and treatment of high altitude pulmonary edema by a calcium channel blocker. Int J Sports Med. Oct 1992;13 Suppl 1:S65-8. [Medline].

  26. Pollard AJ, Niermeyer S, Barry P, et al. Children at high altitude: an international consensus statement by an ad hoc committee of the International Society for Mountain Medicine, March 12, 2001. High Alt Med Biol. Fall 2001;2(3):389-403. [Medline]. [Full Text].

  27. Richalet JP, Gratadour P, Robach P, et al. Sildenafil inhibits altitude-induced hypoxemia and pulmonary hypertension. Am J Respir Crit Care Med. Feb 1 2005;171(3):275-81. [Medline].

  28. Sartori C, Allemann Y, Duplain H, et al. Salmeterol for the prevention of high-altitude pulmonary edema. N Engl J Med. May 23 2002;346(21):1631-6. [Medline].

  29. Schoene RB. Fatal high altitude pulmonary edema associated with absence of the left pulmonary artery. High Alt Med Biol. Fall 2001;2(3):405-6. [Medline].

  30. Schoene RB. Unraveling the mechanism of high altitude pulmonary edema. High Alt Med Biol. Summer 2004;5(2):125-35. [Medline].

  31. Schoene RB, Hackett PH, Henderson WR, et al. High-altitude pulmonary edema. Characteristics of lung lavage fluid. JAMA. Jul 4 1986;256(1):63-9. [Medline].

  32. Shlim DR, Papenfus K. Pulmonary embolism presenting as high-altitude pulmonary edema. Wilderness Environ Med. May 1995;6(2):220-4. [Medline].

  33. Swenson ER, Maggiorini M, Mongovin S, et al. Pathogenesis of high-altitude pulmonary edema: inflammation is not an etiologic factor. JAMA. May 1 2002;287(17):2228-35. [Medline].

  34. Taber R. Protocols for the use of a portable hyperbaric chamber for the treatment of high altitude disorders. J Wilderness Med. 1990;1:181-92.

  35. West JB. The physiologic basis of high-altitude diseases. Ann Intern Med. Nov 16 2004;141(10):789-800. [Medline].

  36. West JB, Colice GL, Lee YJ, et al. Pathogenesis of high-altitude pulmonary oedema: direct evidence of stress failure of pulmonary capillaries. Eur Respir J. Apr 1995;8(4):523-9. [Medline].

  37. Zafren K, Reeves JT, Schoene R. Treatment of high-altitude pulmonary edema by bed rest and supplemental oxygen. Wilderness Environ Med. May 1996;7(2):127-32. [Medline].

Previous
Next
 
High-altitude pulmonary edema (HAPE). Image courtesy Dr Peter Hackett.
Hyperbaric treatment at 4250 m in a Gamow bag.
Thoracic ultrasonography: comet tail sign. Patient with acute high-altitude pulmonary edema (HAPE). Note wedge-shaped forms extending from pleural lining. In contrast, normal thoracic sonogram (below) reveals only diffuse, "snow storm" appearance. Courtesy of Dr Peter Fagenholz, et al.
Thoracic ultrasonography. Normal thoracic sonogram reveals only diffuse, "snow storm" appearance without comet tail sign. Courtesy of Dr Peter Fagenholz, et al.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.