Santiago Martinez-Jimenez MD, Presenter: Nothing to Disclose

Jorge Carrillo, Abstract Co-Author: Nothing to Disclose

Jae Woo Song MD, Abstract Co-Author: Nothing to Disclose

Aura L Rivera, Abstract Co-Author: Nothing to Disclose

Holman Page McAdams MD, Abstract Co-Author: Stockholder, General Electric Company Author with royalties, Reed Elsevier plc

Carlos Santiago Restrepo MD, Abstract Co-Author: Nothing to Disclose

To report radiographic and CT findings in patients with high altitude pulmonary edema (HAPE).

We retrospectively identified 10 patients, 8 male and 2 female, age range 5 to 27 years (mean 13.5 years), who presented to our emergency department with respiratory symptoms and recent history (0 hours to 5 days) of travel from 2000 m. Initial chest radiographs (n=10) and thin-section CT (n=9) were assessed by two thoracic radiologists in consensus for distribution and characteristics of opacities. Follow-up radiographs (n=10) and CT (n=2), obtained 47 to 72 hours after presentation, were also reviewed. Clinical data were reviewed to exclude other causes of lung edema or infection.

All initial radiographs and CTs were abnormal. Initial radiographs showed bilateral, asymmetric, mid-to-upper lung predominant airspace nodules (n=10), usually with coalescent opacities (n=9). Initial CT showed bilateral, asymmetric, ground-glass and airspace nodular opacities in a distinct peribronchovascular distribution (n=10) and with subpleural sparing (n=9); intralobular septal thickening was frequently identified within the nodules (“crazy-paving”, n=7). Interlobular septal thickening, pleural effusion and enlarged cardiac silhouette were absent. Follow-up radiographs and/or CT showed near complete resolution in all patients.

HAPE typically manifests on chest radiographs with airspace nodules in a mid-and-upper lobe distribution. CT shows ground-glass and airspace nodules in a peribronchovascular distribution, often with a “crazy-paving” appearance. Septal lines, pleural fluid and cardiomegaly are typically absent. Resolution is typically rapid and complete.

The findings of HAPE are distinctive and suggest the diagnosis in the appropriate clinical context.

Martinez-Jimenez, S, Carrillo, J, Song, J, Rivera, A, McAdams, H, Restrepo, C, High Altitude Pulmonary Edema: Radiographic and CT Findings.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4430285.html