Pulmonary Embolism Masquerading as High Altitude Pulmonary Edema at High Altitude

Abstract

Pandey, Prativa, Benu Lohani, and Holly Murphy. Pulmonary embolism masquerading as high altitude pulmonary edema at high altitude. High Alt Med Biol. 17:353–358, 2016.—Pulmonary embolism (PE) at high altitude is a rare entity that can masquerade as or occur in conjunction with high altitude pulmonary edema (HAPE) and can complicate the diagnosis and management. When HAPE cases do not improve rapidly with descent, other diagnoses, including PE, ought to be considered. From 2013 to 2015, we identified eight cases of PE among 303 patients with initial diagnosis of HAPE. Upon further evaluation, five had deep vein thrombosis (DVT). One woman had a contraceptive ring and seven patients had no known thrombotic risks. PE can coexist with or mimic HAPE and should be considered in patients presenting with shortness of breath from high altitude regardless of thrombotic risk.

Pulmonary Artery Thrombosis: A Diagnosis That Strives for Its Independence

“…Unfortunately, there is no separate analysis of the groups of patients with PE and pulmonary thrombosis in the study. However, reviewing again the individual clinical cases could give the information about the isolated PA thrombosis with involvement of its large and segmental branches in patients from a high altitude [ 29 ].…”

The Complexity of Diagnosing High-Altitude Pulmonary Edema: A Case Report and Review of the Differential Diagnosis of Greater Than Expected Hypoxemia at Altitude

“…Common conditions, however, including pulmonary hypertension, pulmonary embolism, pneumonia, asthma, chronic obstructive pulmonary disease, pneumothorax, diseases associated with respiratory muscle weakness, control of ventilation disorders, congestive heart failure, myocardial infarction, intracardiac shunts, extracardiac shunts, hyperthyroidism, chronic kidney disease, and severe anemia, can all contribute to hypoxemia and exercise intolerance at altitude (Table 3). Although the physical activity associated with adventure travel alone would seem to reduce the risk of venous thrombosis, case reports exist of pulmonary embolism masquerading as HAPE and altitude-associated hypoxia itself appears to increase the risk of thromboembolic events (Brill et al, 2013;Hull et al, 2016;Pandey et al, 2016) due to increase in blood viscosity with polycythemia, dehydration, and periods of forced inactivity with changes in weather or other factors. Pneumonia will also often manifest with clinical signs such as fever, tachycardia, and localized adventitious lung sounds, and can have a similar clinical picture to HAPE.…”

Pulmonary embolism, frostbite and high-altitude retinopathy – a combination of life- and sight-threatening vascular complications at high altitude

“…The reported occurrence of pulmonary embolism at altitude is rare, and to our knowledge has only been described in seven case reports. [2][3][4][5] Its occurrence could be underestimated, as it may indeed be a cause of sudden death in trekkers, but as post mortems are infrequently carried out in such settings, there is no definite evidence for this. 2 With acclimatisation to the hypoxia of altitude, increased blood viscosity is seen due to haemoconcentration, polycythaemia and a rise in haematocrit.…”

“…2 With acclimatisation to the hypoxia of altitude, increased blood viscosity is seen due to haemoconcentration, polycythaemia and a rise in haematocrit. 4 This, added to the cold environment causing peripheral vasoconstriction and 'sluggish' blood flow, would seem to make thrombus formation more likely. However, the literature does not support a clear association between the risk of pulmonary embolism and altitude, although a prolonged stay at altitude may be a risk factor.…”

“…However, the literature does not support a clear association between the risk of pulmonary embolism and altitude, although a prolonged stay at altitude may be a risk factor. 4,5 High altitude pulmonary oedema (HAPE) is the most common pathology causing excessive breathlessness at altitude; pulmonary embolism, being less common, may be misdiagnosed as HAPE. Shortness of breath due to HAPE will usually settle quickly with descent and oxygen, whereas with pulmonary embolism, symptoms will likely persist.…”