Altitude Illness - Pulmonary Syndromes Workup

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

Laboratory Studies

  • Use Gram stain or culture to evaluate for cases requiring antibiotic therapy.
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Imaging Studies

  • Chest radiography
    • The chest radiograph is usually irrelevant to field diagnosis and management but is useful in the context of a high-altitude clinic or hospital.
    • Patchy, asymmetric, unilateral or bilateral fluffy infiltrates and a normal cardiac silhouette are characteristic of HAPE.
  • Thoracic ultrasonography (comet tail sign)
    • Recent reports reveal thoracic ultrasonographic assessment for comet tail signs to be sensitive in making the diagnosis of HAPE and grading clinical severity (see images below).[5] Thoracic ultrasonography: comet tail sign. PatientThoracic 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 sonogramThoracic ultrasonography. Normal thoracic sonogram reveals only diffuse, "snow storm" appearance without comet tail sign. Courtesy of Dr Peter Fagenholz, et al.
    • Standard thoracic ultrasonography uses 28 standard views across the anterior chest and can be completed in minutes.
    • Comet tail signs are artifacts resulting from increased pulmonary edema.
    • Advantages of ultrasonography include portability of equipment, use of nonionizing radiation, rapidity of assessment, and ease of reassessment.
    • Current studies are ongoing to define sensitivity and rate of response of ultrasonography versus standard radiography.
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Other Tests

  • Pulse oximetry
    • Although unnecessary for diagnosis, pulse oximetry is very helpful for in-the-field differentiation of HAPE, high-altitude cough, and other less serious respiratory problems.
    • HAPE demonstrates arterial oxygen desaturation relative to normal for the altitude at which measurement is made.
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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

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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.
 
 
 
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