Pulmonary embolism presenting as high-altitude pulmonary edema

High-altitude pulmonary edema (HAPE) is a recognized risk of rapid ascent to high altitude. Since the recognition of this entity more than 30 years ago, most pulmonary deaths at high altitude have been attributed to HAPE. However, as the bodies can almost never be recovered for postmortem examination, rare diagnoses that appear clinically similar to HAPE will not be recognized. A 33-year-old woman climbing on Mt. Everest, and taking oral contraceptive pills, developed what seemed to be severe HAPE. Examination after she was evacuated from the mountain revealed a deep venous thrombosis in her left leg and multiple pulmonary emboli. We propose that multiple pulmonary emboli at high altitude can mimic HAPE, and fatal pulmonary embolism may be an explanation for some alleged victims of HAPE who died despite what should have been adequate descent.