True altums are much taller and have different coloration. They usually have a deeper brown/gold body color with thick, dark brown bars. Peruvian "altums" are actually just Peruvian scalare. They have most of the scalare characteristics -- lighter silver body color, thinner black bars, and don't grow quite as large (true altums get to be very tall fish!). The only thing that really sets them apart is the notched nose, which is what makes them similar in appearance to altums.
For comparison:
Adult altum
Adult Peruvian scalare
Juvenile altum
Juvenile Peruvian scalare
After looking at them for a while the difference becomes really easy to spot. The Peruvian scalare tend to look a bit thinner and daintier, with very long trailing fins. The true altums seem much more tall and the stripes are way broader.
I've always loved the long, curved ventral fins on the Peruvians. The way they curl around and hook backwards toward the tail is really attractive. They make great crosses with domestic angels if you like impressive fins on angels.