Int J Sports Med 1998; 19(3): 220-222
DOI: 10.1055/s-2007-971908
Orthopaedics and Clinical Science

© Georg Thieme Verlag Stuttgart · New York

Cough Induced Stress Fracture and Arthropathy of the Ribs at Extreme Altitude

J. A. Litch1 , M. Tuggy2
  • 1Himalayan Rescue Association, Kathmandu, Nepal
  • 2Swedish Hospital Medical Center, Seattle, WA, USA
Further Information

Publication History

Publication Date:
09 March 2007 (online)

Cough and chest wall pain at high altitude have only received passing mention in the medical literature. Increased minute ventilation of cold dry air at very high altitude is likely to cause airway irritation. This in turn may result in airway drying, mucus production, postnasal drip from vasomotor rhinitis, and bronchospasm acting individually or in combination to stimulate the vagal cough reflex. The cough is exacerbated further at extreme altitudes above 5500 m, and may result in intercostal muscle strain and single or multiple rib fractures. We present a case of multiple cough induced stress fractures and arthropathy documented by technetium-99 bone scan in a high altitude climber and suggest the addition of the term High Altitude Cough Syndrome (HACS) to the medical syntax to identify this discrete medical problem of exposure to very high altitude.