Altitude Illness - Pulmonary Syndromes Workup

Updated: Jun 22, 2022
  • Author: N Stuart Harris, MD, MFA, FACEP; Chief Editor: Joe Alcock, MD, MS  more...
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Workup

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 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 Thoracic ultrasonography. Normal thoracic sonogram reveals only diffuse, "snow storm" appearance without comet tail sign. Courtesy of Dr Peter Fagenholz, et al.

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.