Point-of-Care Ultrasound Diagnosis of Community-Acquired Pneumonia in a High-Altitude, Resource-Poor Setting

Abstract

Objective: Point-of-care ultrasound (POCUS) for the evaluation of patients with suspected high-altitude pulmonary edema can be a useful tool in remote, high-altitude areas. The same technique can also yield high differential diagnostic accuracy for other relevant causes of acute respiratory distress at high altitude. With the recent development of high-quality, hand-held ultrasound devices, POCUS can be used with increasing reliability in such environments. We present a case of severe respiratory disease in a young, otherwise healthy patient during a trek at high altitude in the Khumbu valley of Nepal. Methods: By using POCUS, we were able to exclude several important differential diagnoses and diagnose the patient with community-acquired pneumonia. Results: Our findings allowed us to start early on-site treatment and positively influenced shared decision-making with the patient, which led to a helicopter evacuation. Conclusions: This case illustrates that POCUS can be a valuable tool in remote, high-altitude regions and could allow healthcare providers to diagnose and follow-up with patients exhibiting acute respiratory symptoms when other radiological imaging modalities are not available.

Keywords: acclimatization; altitude sickness; dyspnea; pulmonary edema.