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A case of high altitude pulmonary oedema (HAPE) in a climber who made a rapid ascent on Mt McKinley (Denali), Alaska is described. The bronchoalveolar lavage (BAL) fluid contained increased numbers of red blood cells and an abundance of haemosiderin laden macrophages consistent with alveolar haemorrhage. The timing of this finding indicates that alveolar haemorrhage began early during the ascent, well before the onset of symptoms. Although evidence of alveolar haemorrhage has been reported at necropsy in individuals dying of HAPE, previous reports have not shown the same abundance of haemosiderin laden macrophages in the BAL fluid. These findings suggest that alveolar haemorrhage is an early event in HAPE.

The clinical features and necropsy findings are described for seven trekkers in the Himalayas whose deaths were related to high altitude. The fatal outcome was due to serious pulmonary and cerebral disease. Oedema of the lungs and brain was prominent but so was thrombosis and haemorrhage, features of acute mountain sickness that have received insufficient recognition in the past. Most of the men were middle aged. Some began their trekking soon after flying to high altitude before becoming acclimatised and some remained at high altitude or climbed even higher despite the development of vomiting, breathlessness, and exhaustion. In one case death occurred despite prompt recognition and treatment of symptoms by administration of oxygen and swift evacuation to low altitude.