Mediastinal Emphysema and Pneumothorax in High Altitude Pulmonary Edema

Abstract

Two cases of high-altitude pulmonary edema complicated by mediastinal emphysema and pneumothorax are presented, one of which required air drainage from both pleural spaces as an emergency measure. The pathogenesis of the process is discussed, which, by pathological and experimental observations, is explained by the rupture of alveoli and air leakage into the perivascular sheaths from where it continues to the mediastinum or the peripheral subpleural space. Perforation of the pleura and invasion of the pleural cavity can then occur. The importance of recognition and treatment of the aforementioned complication is emphasized, and its rarity and possible causes are pointed out.