Edema pulmonar agudo de reascenso: Caso observado en Huaraz, Ancash, Perú / Acute Pulmonary Edema Returning to a High Altitude Environment: Report of a Case Observed in Huaraz, Ancash, Peru

RESUMEN

Introducción: la exposición brusca a las grandes alturas en un individuo susceptible puede producir edema pulmonar de altura (EPA) que es de dos tipos ascenso y reascenso; éste último afecta a nativos de altura cuando retornan a sus lugares de origen, luego de permanecer un tiempo a baja altitud. Caso clínico se presenta un caso de EPA de reascenso en un varón saludable de 17 años nativo de grandes alturas (3 400 m.s.n.m), que se observó en el Hospital ôVíctor Ramos Guardiaõ de Huaraz-Ancash (3 100 m.s.n.m), 48 horas después de haber retornado a su lugar de origen; luego de permanecer 21 días en Lima. Acudió a Emergencia con tos y expectoración, disnea de reposo, dolor torácico, taquìpnea, taquicardia y crepitantes pulmonares. La radiografía del tórax y la hipoxemia detectada contribuyeron a precisar el diagnóstico. A pesar del severo compromiso clínico- radiológico, mejoró a las 48 horas y salió de alta un día después. Se revisan los mecanismos fisiopatològicos, tratamiento y prevención.

ABSTRACT

Introduction: Sudden exposure to a high altitude environment in a susceptible individual may lead to the occurrence of high altitude acute pulmonary edema, a condition that has two types ascending and returning; the latter affects people native from high altitude when they return to their places, after spending some time in low altitude environments. Case Report We present the case of a healthy 17-year old male patient born in a high altitude environment (3400 meters above sea level) who was admitted in Victor Ramos-Guardia Hospital in Huaraz (3100 meters above sea level), 48 hours after returning back to his home place, subsequent to having been in Lima for 21 days. He was brought to the emergency room with productive cough, dyspnea at rest, chest pain, tachypnea, tachycardia, and abnormal respiratory sounds (crackles). Chest X-ray films and hypoxemia contributed to make a precise diagnosis. In spite of his severely deteriorated condition, he improved after 48 hours and was discharged one day later. Pathophysiology mechanisms, therapy, and prevention of high altitude pulmonary edema are reviewed.