Alveolar haemorrhage in a case of high altitude pulmonary oedema

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