[High altitude pulmonary edema at a medium height. A case report]

A 45-year-old, healthy, well-trained man climbed within 12 hours from 300 m above sea level to a shelter at 2500 m in the Tyrolean Alps. During the following 3 days he undertook ski tours to the surrounding mountains up to 3356 m. On the 4th day he suddenly suffered from headache, coughing and very severe dyspnoea even at rest, accompanied by loss of appetite and the feeling of suffocation. The following day he was rescued by a helicopter and taken to hospital. At the time of admission the patient was severely hypoxaemic (capillary PO2 = 25.7 mmHg), and the chest X-ray revealed signs of bilateral alveolar pulmonary edema localised predominantly in the right lung. High-altitude pulmonary edema (HAPE) was diagnosed because of the typical clinical course. Pulmonary gas exchange normalised within hours, and complete restitution was achieved within 2 days. The chest X-ray was normal on the 4th day after admission. HAPE is a non-cardiogenic pulmonary edema which develops in healthy individuals usually above 3000 m. Among the predisposing factors are rapid ascent, severe physical effort, diminished hypoxic ventilatory response and abnormal fluid balance. The treatment of choice is descent to a lower altitude, administration of oxygen and of nifedipine and expiratory positive airway pressure.