A pleasant surprise and a very uncommon differential diagnosis of high altitude pulmonary edema (HAPE)

An 18-year-old Sherpani resident at Dingboche (4410 m, Solokhumbu, Nepal) had been prediagnosed by the staff of Himalaya Rescue Aid Post Members at Pheriche with High Altitude Pulmonary Edema (HAPE) when they asked us – staying incidentally there on the way for a research project at Kalar Patthar/Mt.Everest – to assist them. Echocardiography showed normal ventricular function without pulmonary hypertension (PaP ∼25 mmHg), but some questionable B lines at the right side, physiological mitral valve insufficiency and no tricuspidal insufficiency, but a minimal pericardial effusion of 2–4 mm around the right ventricle. [...]she refused to ride a horse for financial reasons and walked instead (12–14 hrs, based on Google Earth a total altitude difference of about ∼1200 m with all ascents and descents included)!