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Background
Every year a large number of children travel to high altitudes, either on their way back to their place of residence or as holiday destinations, and although most of these situations happen without complications, there is a small percentages of cases that can present high altitude illness, such as high altitude pulmonary edema (HAPE). This entity is considered a type of noncardiogenic pulmonary edema that occurs after rapid ascent to altitudes above 2500-3000 meters (8202-9842 ft) above sea level. HAPE can develop at any age, but it is believed it is more frequent in children than in adults, despite the lack of available information about its prevalence and incidence due to the high rate of underreporting. This pathology shares several aspects between adults and the pediatric population; however, in the latter some particularities must be taken into account. We present a case-series comprising 20 children with diagnoses of reentry HAPE to illustrate the clinical characteristics, common imaging findings in chest x-ray, treatment, and outcomes in patients with this pathology.

Educational Goals / Teaching Points
To recognize the main radiological findings that can be found on chest radiography in pediatric patients with HAPE and the key to its diagnosis. To reinforce that not all alveolar opacities on a chest radiograph correspond to an infectious etiology, and that HAPE is also a differential diagnosis in pediatric patients.To report the clinical and radiological outcomes in our cohort of pediatric patients with HAPE.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Regarding our patients, in the radiographic evaluation and according to their age, three patients had increased cardiothoracic ratio, four decreased, and the rest were normal. Only two cases showed cephalization of blood flow, three patients with wide vascular pedicle, and half of the sample had enlarged pulmonary hila. No septal lines, neither air bronchogram nor pleural effusions, were seen in plain films. The 10% had affectation of one quadrant, 45% had two quadrants, 25% had three quadrants, and 20% had four quadrants, 2 quadrants was most common, with a pattern of distribution in both apices and upper lobes. The right lung was most frequently affected in both bilateral and unilateral presentations. In addition, one of the keys to radiologic diagnosis is the rapid resolution of findings with the onset of supplemental oxygen. As described in the literature, the HAPE radiological pattern is characterized by patchy opacities of bilateral and peripheral distribution, without signs of subjacent cardiogenic etiology and is located predominantly in upper lobes and apices.

Conclusion
HAPE is a pathology that also affects the pediatric population because nowadays children are exposed to changes in altitude while traveling; therefore, it is important to know that respiratory symptoms associated with alveolar opacities in x-rays are not always attributed to an infectious cause and other differential diagnoses like this disease should be kept in mind. An adequate assessment is essential because it is a life-threatening condition.