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).^[21]

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.

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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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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.

Treatment & Management

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Media Gallery

High-altitude pulmonary edema (HAPE). Image courtesy Dr Matthew Cushing.
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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Author

N Stuart Harris, MD, MFA, FACEP Chief, Division of Wilderness Medicine, Fellowship Director, MGH Wilderness Medicine Fellowship, Attending Physician, Massachusetts General Hospital; Assistant Professor, Department of 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, Massachusetts Medical Society, International Society for Mountain Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Society for Academic Emergency Medicine, Canadian Association of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Joe Alcock, MD, MS Associate Professor, Department of Emergency Medicine, University of New Mexico Health Sciences Center

Joe Alcock, MD, MS is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Samuel M Keim, MD, MS Professor and Chair, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD, MS 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, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Thomas E Dietz, MD Consulting Staff, Department of Emergency Medicine, Providence Hood River Memorial Hospital

Disclosure: Nothing to disclose.

Sara W Nelson, MD Resident 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.