Severe. The symptoms and signs are more serious than those in severe HAPE. Patients are at high risk Pulmonary Medicine 3 of dying. They have a pale complexion, weak breathing, and a large amount of foam is discharged from the nose and mouth. A gurgling sound is audible in the bilateral lungs. The heart sounds are weak, and blood pressure is decreased. The patient is also likely to have high-altitude cerebral edema. Heart failure and secondary pulmonary infection are very likely. Chest X-rays reveal flocculent shadows in unilateral or bilateral lungs, enlargement of the heart, and the pulmonary artery is particularly clear. CT scans show diffuse alveolar edema in unilateral or bilateral lungs. The number of white blood cells is > 16 × 10 9 /L.