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Pulmonary embolism presenting as high-altitude pulmonary edema
1CIWEC (Canadian International Water and Energy Consultants) Clinic, Kathmandu, Nepal.
Wilderness & Environmental Medicine
|May 1, 1995
Summary
High-altitude pulmonary edema (HAPE) can be mimicked by pulmonary embolisms. This condition, often fatal, may explain some deaths attributed to HAPE at high altitudes.
Area of Science:
- Altitude Medicine
- Pulmonary Medicine
- Cardiovascular Medicine
Background:
- High-altitude pulmonary edema (HAPE) is a significant risk associated with rapid ascent to high altitudes.
- Historically, HAPE has been the primary diagnosis for most high-altitude pulmonary deaths.
- Postmortem examinations are rarely feasible, hindering the recognition of alternative diagnoses.
Observation:
- A 33-year-old female climber on Mt. Everest, using oral contraceptives, presented with symptoms suggestive of severe HAPE.
- Evacuation and subsequent examination revealed deep venous thrombosis in her left leg and multiple pulmonary emboli.
Findings:
- Multiple pulmonary emboli can present clinically similarly to HAPE.
- Fatal pulmonary embolism is a potential, underrecognized cause of death in high-altitude environments.
Implications:
- This finding suggests that pulmonary embolism should be considered in the differential diagnosis of suspected HAPE, especially in cases with unexplained fatalities.
- Revising diagnostic criteria and considering thromboprophylaxis in certain high-risk individuals may be warranted.
- Further research is needed to elucidate the incidence and specific risk factors for pulmonary embolism at high altitudes.