Causes of Blue baby

• Cardiovascular disease
  –Cardiogenic shock (e.g., massive MI)
  –Severe valvular heart disease
  –Cor pulmonale
  –Massive pulmonary embolus
• Abnormal hemoglobin
  –Methemoglobinemia: Usually caused by drugs or chemicals (e.g., sulfa, nitrites, benzene derivatives) or genetic defects
  –Hemoglobin Kansas
  –Sickle cell disease
  • Toxins/poisons (e.g., carbon monoxide, nitroprusside, cyanide)
  
  Peripheral cyanosis (cyanosis of phalanges, earlobes, and nose)
  • Increased resistance to blood flow
    –Raynaud's phenomenon
    –Acrocyanosis
    –Superior vena cava obstruction
    –Venous hypertension
    –Arterial embolism
    –Exposure to cold air or water
  • Decreased cardiac output
    –Shock
    –Congestive heart failure
    –Mitral stenosis
  • Increased blood viscosity
    –Polycythemia vera

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Cyanosis: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Recall the pathway for oxygen, from the air to the tissue; etiology is often multifactorial
• Reduced O2 availability: High altitude (>6,000 feet), e.g., air travel, ski resort, mountain travel
• Reduced O2 transport to alveoli: Respiratory failure/arrest, air flow obstruction (usually compensate for large obstruction unless complete); restrictive chest wall disease (e.g., kyphosis, weakness, or obesity)
• Abnormal gas exchange or V/Q mismatch: Most common physiologic pulmonary cause of hypoxia

• Abnormal ventilation
  –Alveolar diseases: Pneumonia, pulmonary edema, diffuse alveolar damage, alveolar proteinosis
  –Conducting airway diseases: Asthma, bronchiolitis
  –Combined pathology: ARDS, bronchopulmonary dysplasia, HMD

• Abnormal perfusion
  –Pulmonary hypertension, pulmonary embolus, abnormal anatomy (e.g., pulmonary sequestration)
• Shunt
  –Intrapulmonary shunt (or “total” V/Q mismatch), e.g., AV malformations
  –Extrapulmonary shunt, e.g., TOF, TAPVR, TGA
• Abnormal transport to tissue
  –Abnormal hemoglobin: β-thalassemia, sickle cell disease, CO poisoning
  –Decreased hemoglobin: Anemia, blood loss
  –Decreased blood flow: Dysrhythmia, bradycardia, cardiac arrest, hypotension
  • Abnormal O2 delivery at tissue
    –Abnormal hemoglobin affinity for O2
    –End-organ failure (e.g., mitochondrial disease, cyanide poisoning)
  • Chronic cyanosis starting at birth suggests either congenital lesion or neonatal injury (e.g., meconium aspiration, group B streptococcus sepsis, HMD)

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Cyanosis: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Arteriosclerotic occlusive disease (chronic).

With arteriosclerotic occlusive disease, peripheral cyanosis occurs in the legs whenever they're in a dependent position. Associated signs and symptoms include intermittent claudication and burning pain at rest, paresthesia, pallor, muscle atrophy, weak leg pulses, and impotence. Late signs are leg ulcers and gangrene.

Bronchiectasis.

Bronchiectasis produces chronic central cyanosis. Its classic sign, however, is a chronic productive cough with copious, foul-smelling, mucopurulent sputum or hemoptysis. Auscultation reveals rhonchi and coarse crackles during inspiration. Other signs and symptoms include dyspnea, recurrent fever and chills, weight loss, malaise, clubbing, and signs of anemia.

Buerger's disease.

With Buerger's disease, exposure to cold initially causes the feet to become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication of the instep is characteristic; it's aggravated by exercise and smoking and relieved by rest. Associated signs and symptoms include weak peripheral pulses and, in later stages, ulceration, muscle atrophy, and gangrene.

Chronic obstructive pulmonary disease (COPD).

Chronic central cyanosis occurs in advanced stages of COPD and may be aggravated by exertion. Associated signs and symptoms include exertional dyspnea, a productive cough with thick sputum, anorexia, weight loss, pursed-lip breathing, tachypnea, and the use of accessory muscles. Examination reveals wheezing and hyperresonant lung fields. Barrel chest and clubbing are late signs. Tachycardia, diaphoresis, and flushing may also accompany COPD.

Deep vein thrombosis.

With deep vein thrombosis, acute peripheral cyanosis occurs in the affected extremity associated with tenderness, painful movement, edema, warmth, and prominent superficial veins. Homans'sign can also be elicited.

Heart failure.

Acute or chronic cyanosis may occur in patients with heart failure. Typically, it's a late sign and may be central, peripheral, or both. With left-sided heart failure, central cyanosis occurs with tachycardia, fatigue, dyspnea, cold intolerance, orthopnea, a cough, a ventricular or an atrial gallop, bibasilar crackles, and a diffuse apical impulse. With right-sided heart failure, peripheral cyanosis occurs with fatigue, peripheral edema, ascites, jugular vein distention, and hepatomegaly.

Lung cancer.

Lung cancer causes chronic central cyanosis accompanied by a fever, weakness, weight loss, anorexia, dyspnea, chest pain, hemoptysis, and wheezing. Atelectasis causes mediastinal shift, decreased diaphragmatic excursion, asymmetrical chest expansion, a dull percussion note, and diminished breath sounds.

Peripheral arterial occlusion (acute).

Peripheral arterial occlusion produces acute cyanosis of one arm or leg or, occasionally, both legs. The cyanosis is accompanied by sharp or aching pain that worsens when the patient moves. The affected extremity also exhibits paresthesia, weakness, and pale, cool skin. Examination reveals a decreased or an absent pulse and increased capillary refill.

Pneumonia.

With pneumonia, acute central cyanosis is usually preceded by a fever, shaking chills, a cough with purulent sputum, crackles, rhonchi, and pleuritic chest pain that's exacerbated by deep inspiration. Associated signs and symptoms include tachycardia, dyspnea, tachypnea, diminished breath sounds, diaphoresis, myalgia, fatigue, a headache, and anorexia.

Pneumothorax.

A cardinal sign of pneumothorax, acute central cyanosis is accompanied by sharp chest pain that's exacerbated by movement, deep breathing, and coughing; asymmetrical chest wall expansion; and shortness of breath. The patient may also exhibit rapid, shallow respirations; a weak, rapid pulse; pallor; jugular vein distention; anxiety; and the absence of breath sounds over the affected lobe.

Polycythemia vera.

 A ruddy complexion that can appear cyanotic is characteristic in polycythemia vera, which is a chronic myeloproliferative disorder. Other findings include hepatosplenomegaly, a headache, dizziness, fatigue, aquagenic pruritus, blurred vision, chest pain, intermittent claudication, and coagulation defects.

Pulmonary edema

 With pulmonary edema, acute central cyanosis occurs with dyspnea; orthopnea; frothy, blood-tinged sputum; tachycardia; tachypnea; dependent crackles; a ventricular gallop; cold, clammy skin; hypotension; a weak, thready pulse; and confusion.

Pulmonary embolism.

 Acute central cyanosis occurs when a large embolus causes significant obstruction of the pulmonary circulation. Syncope and jugular vein distention may also occur. Other common signs and symptoms include dyspnea, chest pain, tachycardia, a paradoxical pulse, a dry or productive cough with blood-tinged sputum, a low-grade fever, restlessness, and diaphoresis.

Raynaud's disease.

 With Raynaud's disease, exposure to cold or stress causes the fingers or hands first to blanch and turn cold, then become cyanotic, and finally to redden with a return to a normal temperature. Numbness and tingling may also occur. Raynaud's phenomenon describes the same presentation when associated with other disorders, such as rheumatoid arthritis, scleroderma, or lupus erythematosus.

Shock.

With shock, acute peripheral cyanosis develops in the hands and feet, which may also be cold, clammy, and pale. Other characteristic signs and symptoms include lethargy, confusion, an increased capillary refill time, and a rapid, weak pulse. Tachypnea, hyperpnea, and hypotension may also be present.

Sleep apnea.

 When chronic and severe, sleep apnea causes pulmonary hypertension and cor pulmonale (right-sided heart failure), which can produce chronic cyanosis.

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Cyanosis: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Arteriosclerotic occlusive disease (chronic)

In this disorder, peripheral cyanosis occurs in the legs whenever they’re in a dependent position. Associated signs and symptoms include intermittent claudication and burning pain at rest, paresthesia, pallor, muscle atrophy, weak leg pulses, and impotence. Leg ulcers and gangrene are late signs.

Blast lung injury

Cyanosis is a serious sign of blast lung injury. The impact of this condition on the lungs of affected individuals varies and may include tearing, contusion, edema, and hemorrhage. Other signs and symptoms may include chest pain, wheezing, hemoptysis, and dyspnea. Treatment for patients with blast lung injury typically involves high-flow oxygen, careful fluid management, possible intubation, and close observation in an intensive care setting.

Bronchiectasis

This disorder produces chronic central cyanosis. Its classic sign, though, is a chronic productive cough with copious, foul-smelling, mucopurulent sputum or hemoptysis. Auscultation reveals rhonchi and coarse crackles during inspiration. Other signs and symptoms include dyspnea, recurrent fever and chills, weight loss, malaise, clubbing, and signs of anemia.

Buerger’s disease

In this disorder, exposure to cold initially causes the feet to become cold, cyanotic, and numb; later, they become red, hot, and tingly. Intermittent claudication of the instep, a characteristic sign, is aggravated by exercise and smoking and relieved by rest. Associated signs and symptoms include weak peripheral pulses and, in later stages, ulceration, muscle atrophy, and gangrene.

Chronic obstructive pulmonary disease (COPD)

Chronic central cyanosis occurs in advanced COPD and may be aggravated by exertion. Associated signs and symptoms include exertional dyspnea, a productive cough with thick sputum, anorexia, weight loss, purse-lip breathing, tachypnea, and accessory muscle use. Examination reveals wheezing and hyperresonant lung fields. Barrel chest and clubbing are late signs. Tachycardia, diaphoresis, and flushing may also accompany COPD.

Deep vein thrombosis

In this disorder, acute peripheral cyanosis in the affected extremity is associated with tenderness, painful movement, edema, warmth, and prominent superficial veins. Homans’sign can also be elicited.

Heart failure

Acute or chronic cyanosis may occur in patients with heart failure. It may be central, peripheral, or both and is typically a late sign. In left-sided heart failure, central cyanosis occurs with tachycardia, fatigue, dyspnea, cold intolerance, orthopnea, a cough, ventricular or atrial gallop, bibasilar crackles, and diffuse apical impulse. In right-sided heart failure, peripheral cyanosis occurs with fatigue, peripheral edema, ascites, jugular vein distention, and hepatomegaly.

Lung cancer

This disease causes chronic central cyanosis accompanied by fever, weakness, anorexia, weight loss, dyspnea, chest pain, hemoptysis, and wheezing. Atelectasis causes mediastinal shift, decreased diaphragmatic excursion, asymmetrical chest expansion, a dull percussion note, and diminished breath sounds.

Peripheral arterial occlusion (acute)

This disorder produces acute cyanosis of one arm or leg or, occasionally, of both legs. The cyanosis is accompanied by sharp or aching pain that worsens when the patient moves. The affected extremity also exhibits paresthesia, weakness, and pale, cool skin. Examination reveals decreased or absent pulse and increased capillary refill time.

Pneumonia

In pneumonia, acute central cyanosis is usually preceded by fever, shaking chills, a cough with purulent sputum, crackles, rhonchi, and pleuritic chest pain that’s exacerbated by deep inspiration. Associated signs and symptoms include tachycardia, dyspnea, tachypnea, diminished breath sounds, diaphoresis, myalgia, fatigue, headache, and anorexia.

Pneumothorax

A cardinal sign of pneumothorax, acute central cyanosis is accompanied by dyspnea; sharp chest pain that’s exacerbated by movement, deep breathing, and coughing; and asymmetrical chest wall expansion. The patient may also exhibit rapid, shallow respirations; a weak, rapid pulse; pallor; jugular vein distention; anxiety; and absence of breath sounds over the affected lobe.

Polycythemia vera

A ruddy complexion that can appear cyanotic is characteristic in this chronic myeloproliferative disorder. Other findings include hepatosplenomegaly, headache, dizziness, fatigue, aquagenic pruritus, blurred vision, chest pain, intermittent claudication, and coagulation defects.

Pulmonary edema

In this disorder, acute central cyanosis occurs with dyspnea; orthopnea; frothy, blood-tinged sputum; tachycardia; tachypnea; dependent crackles; ventricular gallop; cold, clammy skin; weak, thready pulse; hypotension; and confusion.

Pulmonary embolism

Acute central cyanosis occurs when a large embolus causes significant obstruction of the pulmonary circulation. Syncope and jugular vein distention may also occur. Other common signs and symptoms include dyspnea, chest pain, tachycardia, paradoxical pulse, a dry cough or a productive cough with blood-tinged sputum, low-grade fever, restlessness, and diaphoresis.

Raynaud’s disease

In Raynaud’s disease, exposure to cold or stress initially causes the fingers or hands to blanch and turn cold, then to become cyanotic, and finally to redden with return of normal temperature. Numbness and tingling may also occur. Raynaud’s phenomenon describes the same presentation when associated with other disorders, such as rheumatoid arthritis, scleroderma, or lupus erythematosus.

Shock

In shock, acute peripheral cyanosis develops in the hands and feet, which may also be cold, clammy, and pale. Other characteristic signs and symptoms include lethargy, confusion, increased capillary refill time, and a rapid, weak pulse. Tachypnea, hyperpnea, and hypotension may also be present.

Sleep apnea

Chronic and severe sleep apnea causes pulmonary hypertension and cor pulmonale (right-sided heart failure), which can produce chronic cyanosis.

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Cyanosis: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Asthma

❑ Chronic obstructive pulmonary disease

❑ Raynaud phenomenon

❑ Hypoventilation

❑ Pulmonary embolism

❑ Cardiac right-to-left shunt

❑ Pulmonary edema

❑ Low cardiac output/shock

❑ Polycythemia vera

❑ Arterial insufficiency

❑ Intrapulmonary shunts

❑ Tracheal obstruction

❑ Tricuspid insufficiency

❑ Superior vena cava obstruction

❑ Pneumonitis

❑ Methemoglobinemia

❑ Patent ductus arteriosus

❑ Pseudocyanosis

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Cyanosis: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

With arteriosclerotic occlusive disease, peripheral cyanosis occurs in the legs whenever they’re in a dependent position. Associated signs and symptoms include intermittent claudication and burning pain at rest, paresthesia, pallor, muscle atrophy, weak leg pulses, and impotence. Late signs are leg ulcers and gangrene. Bronchiectasis produces chronic central cyanosis. Its classic sign, however, is chronic productive cough with copious, foul-smelling, mucopurulent sputum or hemoptysis. Auscultation reveals rhonchi and coarse crackles during inspiration. Other signs and symptoms include dyspnea, recurrent fever and chills, weight loss, malaise, clubbing, and signs of anemia. With Buerger’s disease, exposure to cold initially causes the feet to become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication of the instep is characteristic; it’s aggravated by exercise and smoking and relieved by rest. Associated signs and symptoms include weak peripheral pulses and, in later stages, ulceration, muscle atrophy, and gangrene.

Chronic obstructive pulmonary disease (COPD).

Polycythemia vera.

Pulmonary edema.

Pulmonary embolism.

Raynaud’s disease.

Sleep apnea.

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Cyanosis: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Arteriosclerotic occlusive disease (chronic)

With chronic arteriosclerotic occlusive disease, peripheral cyanosis occurs in the legs whenever they’re in a dependent position. Associated signs and symptoms include intermittent claudication and burning pain at rest, paresthesia, pallor, muscle atrophy, weak leg pulses, and impotence. Late signs are leg ulcers and gangrene.

Bronchiectasis

Bronchiectasis produces chronic central cyanosis. Its classic sign, though, is chronic productive cough with copious, foul-smelling, mucopurulent sputum or hemoptysis. Auscultation reveals rhonchi and coarse crackles during inspiration. Other signs and symptoms include dyspnea, recurrent fever and chills, weight loss, malaise, clubbing, and signs of anemia.

Buerger’s disease

With Buerger’s disease, exposure to cold initially causes the feet to become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication of the instep is characteristic; it’s aggravated by exercise and smoking and relieved by rest. Associated signs and symptoms include weak peripheral pulses and, in later stages, ulceration, muscle atrophy, and gangrene.

Chronic obstructive pulmonary disease

Chronic central cyanosis occurs in advanced stages of chronic obstructive pulmonary disease (COPD) and may be aggravated by exertion. Associated signs and symptoms include exertional dyspnea, productive cough with thick sputum, anorexia, weight loss, pursed-lip breathing, tachypnea, and the use of accessory muscles. Examination reveals wheezing and hyperresonant lung fields. Barrel chest and clubbing are late signs. Tachycardia, diaphoresis, and flushing may also accompany COPD.

Heart failure

Acute or chronic cyanosis may occur in patients with heart failure. Typically, it’s a late sign and may be central, peripheral, or both. With left-sided heart failure, central cyanosis occurs with tachycardia, fatigue, dyspnea, cold intolerance, orthopnea, cough, ventricular or atrial gallop, bibasilar crackles, and diffuse apical impulse. With right-sided heart failure, peripheral cyanosis occurs with fatigue, peripheral edema, ascites, jugular vein distention, and hepatomegaly.

Peripheral arterial occlusion (acute)

Acute peripheral arterial occlusion produces acute cyanosis of one arm or leg or, occasionally, of both legs. The cyanosis is accompanied by sharp or aching pain that worsens when the patient moves. The affected extremity also exhibits paresthesia, weakness, and pale, cool skin. Examination reveals decreased or absent pulse and increased capillary refill time.

Pneumonia

With pneumonia, acute central cyanosis is usually preceded by fever, shaking chills, cough with purulent sputum, crackles, rhonchi, and pleuritic chest pain that’s exacerbated by deep inspiration. Associated signs and symptoms include tachycardia, dyspnea, tachypnea, diminished breath sounds, diaphoresis, myalgia, fatigue, headache, and anorexia.

Pneumothorax

A cardinal sign of pneumothorax, acute central cyanosis is accompanied by sharp chest pain that’s exacerbated by movement, deep breathing, and coughing; asymmetrical chest wall expansion; and shortness of breath. The patient may also exhibit rapid, shallow respirations; weak, rapid pulse; pallor; jugular vein distention; anxiety; and absence of breath sounds over the affected lobe.

Polycythemia vera

A ruddy complexion that can appear cyanotic is characteristic in this chronic myeloproliferative disorder. Other findings in polycythemia vera include hepatosplenomegaly, headache, dizziness, fatigue, aquagenic pruritus, blurred vision, chest pain, intermittent claudication, and coagulation defects.

Pulmonary edema

With pulmonary edema, acute central cyanosis occurs with dyspnea; orthopnea; frothy, blood-tinged sputum; tachycardia; tachypnea; dependent crackles; ventricular gallop; cold, clammy skin; hypotension; weak, thready pulse; and confusion.

Pulmonary embolism

Acute central cyanosis occurs when a large embolus causes significant obstruction of the pulmonary circulation. Syncope and jugular vein distention may also occur. Other common signs and symptoms include dyspnea, chest pain, tachycardia, paradoxical pulse, dry cough or productive cough with blood-tinged sputum, low-grade fever, restlessness, and diaphoresis.

Raynaud’s disease

With Raynaud’s disease, exposure to cold or stress causes the fingers or hands first to blanch and turn cold, then to become cyanotic, and finally to redden with return of normal temperature. Numbness and tingling may also occur. Raynaud’s phenomenon describes the same presentation when associated with other disorders, such as rheumatoid arthritis, scleroderma, or lupus erythematosus.

Shock

With shock, acute peripheral cyanosis develops in the hands and feet, which may also be cold, clammy, and pale. Other characteristic signs and symptoms include lethargy, confusion, increased capillary refill time, and a rapid, weak pulse. Tachypnea, hyperpnea, and hypotension may also be present.

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Cyanosis: Principal Causes of Cyanosis
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Peripheralcyanosis
2. Central cyanosis
   1. Respiratorydisorders
      1. Respiratorydistress syndrome (hyaline membrane disease)
      2. Pneumonia
      3. Bronchiolitis
      4. Asthma
      5. Pneumothorax
      6. Bronchopulmonary dysplasia
      7. Pulmonary malformations
      8. Airway obstruction
      9. Cystic fibrosis
   2. Cardiovascular disorders
      1. Congenitalheart lesions with decreased pulmonary blood flow
         1. Tricuspidatresia with intact ventricular septum and normal origin of thegreat arteries
         2. Ebstein malformation of the tricuspidvalve
         3. Pulmonic atresia with intact ventricularseptum
         4. Ventricular septal defect and pulmonicstenosis or pulmonary atresia (tetralogy of Fallot)
         5. Critical pulmonic stenosis with patentforamen ovale
         6. Complex lesions
      2. Congenital heart lesions with normalor increased pulmonary blood flow
         1. Transposition of the great arteries withintact ventricular septum
         2. Tricuspid atresia with ventricularseptal defect and normal origin of the great arteries
         3. Tricuspid atresia with transpositionof the great arteries
         4. Hypoplastic left heart syndrome
         5. Transposition of the great arterieswith large patent ductus arteriosus or ventricular septal defector both
         6. Double-outlet right ventricle
         7. Truncus arteriosus
         8. Univentricular heart
         9. Total anomalous pulmonary venous return
      3. Persistent pulmonary artery hypertensionof the newborn (persistent fetal circulation)
      4. Pulmonary vascular disease
      5. Pulmonary arteriovenous malformation
   3. Abnormal hemoglobin: methemoglobinemia

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Cyanosis: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Arteriosclerotic occlusive disease (chronic).With arteriosclerotic occlusive disease, peripheral cyanosis occurs in the legs whenever they're in a dependent position. Associated signs and symptoms include intermittent claudication and burning pain at rest, paresthesia, pallor, muscle atrophy, weak leg pulses, and impotence. Late signs are leg ulcers and gangrene.

Blast lung injury.Cyanosis is a serious sign of blast lung injury. The impact of this condition on the lungs of affected individuals varies and may include tearing, contusion, edema, and hemorrhage. Other signs and symptoms may include chest pain, wheezing, hemoptysis, and dyspnea. Treatment for patients with blast lung injury typically involves high-flow oxygen, careful fluid management, possible intubation, and close observation in an intensive care setting.

Bronchiectasis.Bronchiectasis produces chronic central cyanosis. Its classic sign, however, is a chronic productive cough with copious, foul-smelling, mucopurulent sputum or hemoptysis. Auscultation reveals rhonchi and coarse crackles during inspiration. Other signs and symptoms include dyspnea, recurrent fever and chills, weight loss, malaise, clubbing, and signs of anemia.

Buerger's disease.With Buerger's disease, exposure to cold initially causes the feet to become cold, cyanotic, and numb; later, they redden, become hot, and tingle. Intermittent claudication of the instep is characteristic; it's aggravated by exercise and smoking and relieved by rest. Associated signs and symptoms include weak peripheral pulses and, in later stages, ulceration, muscle atrophy, and gangrene.

Chronic obstructive pulmonary disease (COPD).Chronic central cyanosis occurs in advanced stages of COPD and may be aggravated by exertion. Associated signs and symptoms include exertional dyspnea, a productive cough with thick sputum, anorexia, weight loss, pursed-lip breathing, tachypnea, and the use of accessory muscles. Examination reveals wheezing and hyperresonant lung fields. Barrel chest and clubbing are late signs. Tachycardia, diaphoresis, and flushing may also accompany COPD.

Deep vein thrombosis.With deep vein thrombosis, acute peripheral cyanosis occurs in the affected extremity associated with tenderness, painful movement, edema, warmth, and prominent superficial veins. Homans'sign can also be elicited.

Heart failure.Acute or chronic cyanosis may occur in patients with heart failure. Typically, it's a late sign and may be central, peripheral, or both. With left-sided heart failure, central cyanosis occurs with tachycardia, fatigue, dyspnea, cold intolerance, orthopnea, a cough, a ventricular or an atrial gallop, bibasilar crackles, and a diffuse apical impulse. With right-sided heart failure, peripheral cyanosis occurs with fatigue, peripheral edema, ascites, jugular vein distention, and hepatomegaly.

Lung cancer.Lung cancer causes chronic central cyanosis accompanied by a fever, weakness, weight loss, anorexia, dyspnea, chest pain, hemoptysis, and wheezing. Atelectasis causes mediastinal shift, decreased diaphragmatic excursion, asymmetrical chest expansion, a dull percussion note, and diminished breath sounds.

Peripheral arterial occlusion (acute).Peripheral arterial occlusion produces acute cyanosis of one arm or leg or, occasionally, both legs. The cyanosis is accompanied by sharp or aching pain that worsens when the patient moves. The affected extremity also exhibits paresthesia, weakness, and pale, cool skin. Examination reveals a decreased or an absent pulse and increased capillary refill.

Pneumonia.With pneumonia, acute central cyanosis is usually preceded by a fever, shaking chills, a cough with purulent sputum, crackles, rhonchi, and pleuritic chest pain that's exacerbated by deep inspiration. Associated signs and symptoms include tachycardia, dyspnea, tachypnea, diminished breath sounds, diaphoresis, myalgia, fatigue, a headache, and anorexia.

Pneumothorax.A cardinal sign of pneumothorax, acute central cyanosis is accompanied by sharp chest pain that's exacerbated by movement, deep breathing, and coughing; asymmetrical chest wall expansion; and shortness of breath. The patient may also exhibit rapid, shallow respirations; a weak, rapid pulse; pallor; jugular vein distention; anxiety; and the absence of breath sounds over the affected lobe.

Polycythemia vera.A ruddy complexion that can appear cyanotic is characteristic in polycythemia vera, which is a chronic myeloproliferative disorder. Other findings include hepatosplenomegaly, headache, dizziness, fatigue, aquagenic pruritus, blurred vision, chest pain, intermittent claudication, and coagulation defects.

Pulmonary edema.With pulmonary edema, acute central cyanosis occurs with dyspnea; orthopnea; frothy, blood-tinged sputum; tachycardia; tachypnea; dependent crackles; a ventricular gallop; cold, clammy skin; hypotension; a weak, thready pulse; and confusion.

Pulmonary embolism.Acute central cyanosis occurs when a large embolus causes significant obstruction of the pulmonary circulation. Syncope and jugular vein distention may also occur. Other common signs and symptoms include dyspnea, chest pain, tachycardia, a paradoxical pulse, a dry or productive cough with blood-tinged sputum, a low-grade fever, restlessness, anxiety, and diaphoresis.

Raynaud's disease.With Raynaud's disease, exposure to cold or stress causes the fingers or hands first to blanch and turn cold, then become cyanotic, and finally to redden with a return to a normal temperature. Numbness and tingling may also occur. Raynaud's phenomenon describes the same presentation when associated with other disorders, such as rheumatoid arthritis, scleroderma, or lupus erythematosus.

Shock.With shock, acute peripheral cyanosis develops in the hands and feet, which may also be cold, clammy, and pale. Other characteristic signs and symptoms include lethargy, confusion, an increased capillary refill time, and a rapid, weak pulse. Tachypnea, hyperpnea, and hypotension may also be present.

Sleep apnea.When chronic and severe, sleep apnea causes pulmonary hypertension and cor pulmonale (right-sided heart failure), which can produce chronic cyanosis.

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Blue baby as a symptom:

Conditions listing Blue baby as a symptom may also be potential underlying causes of Blue baby. Our database lists the following as having Blue baby as a symptom of that condition:

• Baetz-Greenwalt syndrome

Related information on causes of Blue baby:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Blue baby may be found in:

• Hidden causes of Blue baby