Heavy-duty diesel engines operating in plateau regions experience deteriorated combustion. However, the lack of up-to-date information on the spray-combustion process limits the fundamental understanding of the role of altitude. In this work, the in-cylinder thermodynamic conditions of a real diesel engine operating under different altitudes were reproduced in a constant-volume combustion chamber (CVCC). The liquid spray, ignition, and combustion processes were visualized in detail using different optical diagnostics. Apart from predictable results, some interesting new findings were obtained to improve the understanding of free spray-combustion processes with different altitudes. The spatial distributions of ignition kernels provided direct evidence of higher peak pressure rise rates for high-altitude diesel engines. The percent of stoichiometric air was calculated to confirm that the net effect of altitude was an increase in the amount of air-entrained upstream of the lifted flame; therefore, the soot levels deduced from flame images were inconsistent with those from real engines, revealing that accelerating the soot oxidation process could effectively reduce engine soot emissions in plateau regions. Finally, a novel schematic diagram of the spray flame structure was proposed to phenomenologically describe the role of altitude in influencing the spray-combustion process of a free jet.