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==Causes==
==Causes==
[[Cyanosis]] can be caused by the following mechanisms, systemic arterial oxygen desaturation and increased oxygen extraction by the tissues. Based on these mechanisms, Cyanosis can be either Central or Peripheral. Certain conditions present with bluish purple discoloration of skin or mucous membranes, can mimic cyanosis, are not associated with [[hypoxemia]] or peripheral vasoconstriction and is called Pseudocyanosis.
===Common causes===
====Central cyanosis:====
There following are some of the common causes of Central cyanosis:<ref name="pmid1523025">{{cite journal |vauthors=DiMaio AM, Singh J |title=The infant with cyanosis in the emergency room |journal=Pediatr. Clin. North Am. |volume=39 |issue=5 |pages=987–1006 |date=October 1992 |pmid=1523025 |doi= |url= |author=}}</ref> <ref name="pmid2407997">{{cite journal |vauthors=Driscoll DJ |title=Evaluation of the cyanotic newborn |journal=Pediatr. Clin. North Am. |volume=37 |issue=1 |pages=1–23 |date=February 1990 |pmid=2407997 |doi= |url= |author=}}</ref> <ref name="pmid25604592">{{cite journal |vauthors=Frank DB, Hanna BD |title=Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics |journal=Minerva Pediatr. |volume=67 |issue=2 |pages=169–85 |date=April 2015 |pmid=25604592 |pmc=4382100 |doi= |url= |author=}}</ref> <ref name="pmid22482063">{{cite journal |vauthors=Izraelit A, Ten V, Krishnamurthy G, Ratner V |title=Neonatal cyanosis: diagnostic and management challenges |journal=ISRN Pediatr |volume=2011 |issue= |pages=175931 |date= 2011 |pmid=22482063 |pmc=3317242 |doi=10.5402/2011/175931 |url= |author=}}</ref> <ref name="pmid21462449">{{cite journal |vauthors=Serino G, Giacomazzi F |title=[Pulmonary arterial hypertension in adult patients with congenital heart disease] |language=Italian |journal=Pediatr Med Chir |volume=32 |issue=6 |pages=274–9 |date= 2010 |pmid=21462449 |doi= |url= |author=}}</ref> <ref name="pmid7073040">{{cite journal |vauthors=Curry S |title=Methemoglobinemia |journal=Ann Emerg Med |volume=11 |issue=4 |pages=214–21 |date=April 1982 |pmid=7073040 |doi= |url= |author=}}</ref> <ref name="pmid15342970">{{cite journal |vauthors=Ash-Bernal R, Wise R, Wright SM |title=Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=265–73 |date=September 2004 |pmid=15342970 |doi= |url= |author=}}</ref> <ref name="pmid28722923">{{cite journal |vauthors=Kondamudi NP, Dulebohn SC |title= |journal= |volume= |issue= |pages= |date= |pmid=28722923 |doi= |url= |author=}}</ref>
*'''Conditions associated with decreased concentration of inspired oxygen (FiO2):'''
**[[Smoke inhalation]] most commonly from house fires
**[[Carbon monoxide poisoning]]
**Hydrogen [[cyanide poisoning]]
**Intentional or unintensional exposure to asphyxiating gases (eg, [[Propane]], [[methane]], [[Butane|butane,]] [[Hydrogen sulfide|hydrogen sulphide]])
*'''Decresed atmospheric pressure: [[Altitude sickness|High altitude]]'''
*'''Disorders associated with impairment of chest wall or lung expansion:'''
**External compression
**[[Pneumothorax]]
**[[Hemothorax]]
**[[Flail chest]]
*'''Hypoventilation:'''
**'''Upper airway obstruction:'''
***[[Foreign body aspiration]]
***[[Pertussis]] / [[Croup]]
***[[Epiglottitis]]
***[[Tracheitis]] mostly bacterial
***Traumatic disruption (burns, fractures)
***Congenital airway abnormalities:
****[[Choanal atresia]]
****[[Laryngotracheomalacia]]
****[[Macroglossia]]
****[[Micrognathia]] or [[Retrognathism|retrognathia]] (eg, Pierre-Robin syndrome)
**'''Neurologic abnormalities:'''
***[[CNS depression]]
***Severe head trauma
***[[Apnea of prematurity]]
***Infections (eg, [[meningitis]], [[encephalitis]])
***[[Intraventricular hemorrhage]]
***[[Seizure|Seizures]]
***Cyanotic breath holding spells
***[[Coma]]
**'''Neuromuscular disorders:'''
*** [[Myasthenia gravis]]
***Injury to the phrenic nerve
***Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
**'''Metabolic disorders:'''
***Severe [[hypoglycemia]]
***In born errors of metabolism
*'''Ventilation/perfusion mismatch:'''
**[[Asthma]]
**[[Pulmonary embolism]]
**[[Atelectasis]]
**[[Atelectasis]]
**[[Alveolar capillary dysplasia]]
**[[emphysema]] or [[Chronic obstructive pulmonary disease|COPD]]
**[[Pulmonary edema]]
**Pulmonary hypoplasia
**[[Pulmonary hemorrhage]]
**[[Acute respiratory distress syndrome|Respiratory distress syndrome]] (Hyaline membrane disease)
**[[Transient tachypnea of the newborn]]
*'''Conditions causing impaired oxygen diffusion:'''
**[[Pulmonary fibrosis]]
**[[Pulmonary edema]]
*[[Pneumonia]]
*[[Bronchiolitis]]
*[[Bronchopulmonary dysplasia]]
*[[Cystic fibrosis]]
*[[Empyema]]
*'''Vascular causes:'''
**'''Cyanotic congenital heart diseases (Right to left shunts):'''
***'''Decreased pulmonary flow:'''
****[[Tetralogy of Fallot|Tetralogy of fallot]]
****Tricuspid valve anomalies:
*****[[Tricuspid atresia]]
*****[[Tricuspid stenosis]]
*****[[Ebstein's anomaly of the tricuspid valve|Ebstein's anomaly]]
****[[Pulmonary valve stenosis|Pulmonary stenosis]] (critical valvular)
****[[Pulmonary atresia]] with intact ventricular septum
***'''Increased pulmonary flow:'''
****[[TGA]] (Transposition of great arteries, most common dextro type)
****[[Truncus arteriosus]]
****[[Total anomalous pulmonary venous connection|TAPVC]] (Total anamalous pulmonary venous connection)
***'''Heart failure:'''  Condition that present with cyanosis and  severe heart failure include:
****Left sided obstructive lesion ([[Hypoplastic left heart syndrome|HLHS]])
****[[Aortic coarctation|Coarctation of aorta]]
****Critical valvular [[aortic stenosis]]
**'''[[Eisenmenger's syndrome|Eisenmenger syndrome]]'''
**'''Pulmonary causes:'''
***[[Pulmonary hypertension]]
***[[Pulmonary edema]]
***[[Pulmonary hemorrhage]]
***[[Pulmonary embolism]]
***Pulmonary arterio venous malformations
***Multiple small intrapulmonary shunts
**'''[[Shock]]'''
**'''[[Sepsis]]'''
**'''[[Acute chest syndrome]]'''
*'''Hematologic abnormalities:'''
**[[Methemoglobinemia]] (congenital or acquired)
**[[Sulfhemoglobinemia]] (acquired)
**Hemoglobin mutations with low oxygen affinity: Hb Kansas,  Hb Beth israel, Hb Saint Mande, Hb Bruxells
**[[Polycythemia]]
*Brief resolved unexplained events (BRUE)
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Revision as of 21:32, 21 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Overview

Cyanosis occur because of lack of oxygen in the blood and often due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs (central cyanosis) or due to inadequate circulation to the extremities (peripheral cyanosis). Cyanosis is commonly caused by respiratory disorders and it is also seen in a wide variety of cardiac and vascular disorders and the management depends on the causative factor.

Causes

Cyanosis can be caused by the following mechanisms, systemic arterial oxygen desaturation and increased oxygen extraction by the tissues. Based on these mechanisms, Cyanosis can be either Central or Peripheral. Certain conditions present with bluish purple discoloration of skin or mucous membranes, can mimic cyanosis, are not associated with hypoxemia or peripheral vasoconstriction and is called Pseudocyanosis.

Common causes

Central cyanosis:

There following are some of the common causes of Central cyanosis:[1] [2] [3] [4] [5] [6] [7] [8]

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Causes by Organ System

Cardiovascular Aberrant subclavian artery, acrocyanosis, air embolism, Al Gazali-Aziz-Salem syndrome, alveolar capillary dysplasia , aortic arch defects, aortic coarctation, aortic stenosis, arterial occlusion, atrial myxoma, atrial septal defect, Bindewald-Ulmer-Muller syndrome, Blalock-Taussig shunt, Bland-White-Garland syndrome, blue baby syndrome, Buergers disease, cardiac tamponade, cardiomyopathy, Cassirer disease, cholesterol emboli syndrome, cholesterol pneumonia, congenital heart disease, congestive heart failure, cor biloculare, cor triatriatum, coronary artery anomaly, critical valvular aortic stenosis, Crocq disease, cyanotic congenital heart disease, deep vein thrombosis, double inlet left ventricle, double outlet right ventricle, Ebstein anomaly, Eisenmenger syndrome, familial pulmonary capillary hemangiomatosis, heart attack, hemothorax, hypocalcemia, hypoplastic left heart syndrome, hypovolemia, hypoxemia, idiopathic pulmonary hypertension, intermittent claudication, ischemic heart disease, isolated ventriculoarterial discordance, Ivemark syndrome, Jervell and Lange-Nielsen syndrome, Kugel-Stoloff syndrome, laryngeal edema, malignancy-related superior vena cava syndrome, Marfan syndrome, Meadows syndrome, mitral atresia in infants, myocardial infarction, partial atrioventricular canal, patent ductus arteriosus, patent foramen ovale, peripartum cardiomyopathy, peripheral arterial disease, persistent pulmonary hypertension of the newborn, persistent truncus arteriosus, phlegmasia cerulea dolens, pseudocyanosis, pulmonary arteriovenous fistula, pulmonary arteriovenous malformation, pulmonary embolism, pulmonary hypertension, pulmonary stenosis, pulmonary veno-occlusive disease, pulmonary venous return anomaly, right ventricle hypoplasia, right ventricular outflow tract obstruction, shock, Sneddon syndrome, subpulmonary stenosis, superior vena cava syndrome, TAPVC, Taussig-Bing syndrome, tetralogy of Fallot, total anomalous pulmonary venous connection, transposition of the great vessels, tricuspid atresia, tricuspid stenosis, truncus arteriosus, vascular malposition, vascular rings, velocardiofacial syndrome, ventricular septal defect
Chemical / poisoning 2,4,6-trinitrotoluene, 4-Nitrophenol, anchovy poisoning, aniline, anisidine, antifreeze, apple seed poisoning, apricot seed poisoning, arsine gas, bird cherry seed poisoning, bitter almond seed poisoning, brown snake poisoning, carbamates, chlorate salts, chlorobenzene, chronic mercury exposure, clupeotoxin, cyanide poisoning, demeton-S-methyl, diazinon, dichlorvos, dicrotophos, dinitrocresol, dioxathion, disulfoton, endosulfan, epichlorohydrin, ethion, ethylene glycol, ethylene oxide, ethylene, fensulfothion, fenthion, herring poisoning, hydrogen sulfide, iron poisoning, lantana poisoning, lead, malathion, methidathion, methiocarb, methomyl, organophosphate poisoning, paraquat, parathion, phosdrin, profenofos, propane, sea snake venom, silver iodide, silver nitrate, silver, smoke inhalation, snakebites, stachybotrys chartarum exposure, strychnine, sulfur dioxide, terbufos, tetraethyl pyrophosphate, tetrodotoxin, thioglycolic acid, trichloroethylene
Dermatologic Acrodynia, Al Gazali-Aziz-Salem syndrome, angioneurotic edema, chromhidrosis
Drug Side Effect Acetaminophen and hydrocodone, amiodarone, amyl nitrite, benzocaine, benzodiazepines, beta blockers,bicisate dihydrochloride, bufotenin, chloramphenicol, chloroquine, clonazepam, clorazepate, codeine, dapsone, desmopressin, diazepam, dilaudid, gray baby syndrome, hydrocodone, hydroquinone, ibuprofen, Imipenem-Cilastatin,lorazepam, lortab, maternal sedation, meperidine, methadone, metoclopramide, midazolam, morphine, narcotics, nitrates, nitrazepam, nitrites, nitroglycerin, oxazepam, phenazopyridine, phenol, phenothiazines, primaquine , ribavirin, rifampin, sedatives, sulfonamides
Ear Nose Throat Choanal atresia, epiglottitis, laryngomalacia, laryngotracheomalacia, lethal chondrodysplasia Moerman type, Ludwig's angina, macroglossia, microcephalic osteodysplastic primordial dwarfism type 1, micrognathia, Pierre Robin syndrome, retrognathia, syndromic microphthalmia type 9, vocal cord paralysis, Weinstein Kliman Scully syndrome
Endocrine Adrenal hemorrhage, congenital hyperinsulinism, hypoadrenalism, hypocalcemia, hypoglycemia, hypomagnesemia, pseudoaldosteronism, type 1 pseudohypoaldosteronism, Waterhouse-Friederichsen syndrome, Weinstein Kliman Scully syndrome
Environmental Asbestosis, berylliosis, coal worker's pneumoconiosis, cold exposure, hypersensitivity pneumonitis, insect sting allergy, pneumoconiosis, Shaver's disease, silicosiderosis, silicosis
Gastroenterologic Boerhaave syndrome, Cast syndrome, cirrhosis of liver, congenital diaphragmatic hernia, cystic fibrosis, duodenal atresia, esophageal atresia, tracheal agenesis without tracheoesophageal fistula, tracheoesophageal fistula
Genetic 1p36 deletion syndrome, acrocephalopolysyndactyly, acrofacial dysostosis, benign familial neonatal convulsions, chromosome 22q11 deletion, cystic fibrosis, DiGeorge syndrome, HMG-CoA lyase deficiency, Jervell and Lange-Nielsen syndrome, Marfan syndrome, microcephalic osteodysplastic primordial dwarfism type 1 , Sakati syndrome, Sakati-Nyhan-Tisdale syndrome, Shprintzen syndrome, velocardiofacial syndrome, VLCAD deficiency, Werdnig-Hoffman disease
Hematologic Blood transfusion, cystic hygroma, deep vein thrombosis, disseminated intravascular coagulation, hemoglobinopathy, methemoglobinemia, Osler-Vaquez disease, phlegmasia alba dolens, phlegmasia cerulea dolens, polycythemia vera, pulmonary embolism, sulfhemoglobinemia, Vaquez disease
Iatrogenic Mendelson's syndrome
Infectious Disease Acute histoplasmosis, anthracosis, bacterial tracheitis, bordetella pertussis, epiglottitis, legionellosis, legionnaire's disease, Ludwig's angina, melioidosis, meningitis, pertussis, sepsis, streptococcal group B invasive disease , Waterhouse-Friederichsen syndrome, western equine encephalitis, whooping cough
Musculoskeletal / Ortho Adams–Oliver syndrome, Al Gazali-Aziz-Salem syndrome, Bindewald-Ulmer-Muller syndrome, Isaac's syndrome, lethal chondrodysplasia Moerman type, microcephalic osteodysplastic primordial dwarfism type 1, neuromyotonia, thoracic dystrophy
Neurologic Adams-Oliver syndrome, benign familial neonatal convulsions, Bindewald-Ulmer-Muller syndrome, birth asphyxia, cerebral hypoxia, congenital central hypoventilation syndrome, encephalitis, head trauma, hypoxic ischemic encephalopathy, intracranial hemorrhage, intraventricular hemorrhage, Isaac's syndrome, meningitis, monomelic amyotrophy, mountain sickness, neonatal myasthenia gravis, neuromyotonia, obstructive sleep apnea, perinatal asphyxia, phrenic nerve injury, seizure, sleep apnea, sudden infant death syndrome, suffocation, tonic-clonic seizures, vein of Galen aneurysm, vocal cord paralysis, Werdnig-Hoffman disease, western equine encephalitis
Nutritional / Metabolic Dehydration, diphosphoglycerate mutase deficiency, HMG-CoA lyase deficiency
Obstetric/Gynecologic Meadows syndrome, Mendelson's syndrome, peripartum cardiomyopathy
Oncologic Cystic hygroma, malignancy-related superior vena cava syndrome, Osler-Vaquez disease, Pancoast tumor, polycythemia vera, Vaquez disease
Opthalmologic Matthew-Wood syndrome, Sneddon syndrome, Weinstein Kliman Scully syndrome
Overdose / Toxicity Drug overdose, heroin, phosdrin
Psychiatric Congenital central hypoventilation syndrome, shaken baby syndrome
Pulmonary Acrocyanosis, acute interstitial pneumonitis, air leak syndromes, airway obstruction, alveolar capillary dysplasia, angioneurotic edema, apnea of prematurity, aspiration, asthma, atelectasis, bacterial tracheitis, Besnier-Boeck-Schaumann disease, bronchiectasis, bronchiolitis, bronchopulmonary dysplasia, bronchospasm, Cassirer disease, cholesterol pneumonia, chronic bronchitis, chronic obstructive pulmonary disease, chylothorax, community-acquired pneumonia, congenital central hypoventilation syndrome, congenital cystic adenomatoid malformation, congenital pulmonary lymphangiectasia, Crocq disease, croup, cystic fibrosis, diaphragmatic paralysis, emphysema, empyema, epiglottitis, erythrocyanosis, exercise-induced asthma, extrinsic allergic alveolitis, familial interstitial fibrosis , familial pulmonary capillary hemangiomatosis, fibrosing alveolitis, flail chest, foreign body aspiration, Hamman-Rich syndrome , hemothorax, hyaline membrane disease, hypersensitivity pneumonitis, hypoventilation, hypoxemia, hypoxia (medical), idiopathic diffuse interstitial pulmonary fibrosis, idiopathic pulmonary fibrosis, idiopathic pulmonary hemosiderosis, idiopathic pulmonary hypertension, idiopathic subglottic tracheal stenosis , infant respiratory distress syndrome, infantile apnea, interstitial lung disease, laryngeal cleft, laryngeal edema, laryngomalacia, laryngotracheomalacia, lethal chondrodysplasia Moerman type , lobar emphysema, lung abscess, Matthew-Wood syndrome, meconium aspiration syndrome, Mendelson's syndrome, mountain sickness, obstructive sleep apnea, Pancoast tumor, perinatal asphyxia, Pickwickian syndrome, Pierre Robin syndrome, pleural effusion, pneumoconiosis, pneumonia, pneumothorax, pseudocyanosis, pulmonary alveolar proteinosis, pulmonary arteriovenous fistula, pulmonary arteriovenous malformation, pulmonary artery sling, pulmonary atresia, pulmonary edema, pulmonary embolism, pulmonary fibrosis, pulmonary hemorrhage, pulmonary hypertension, pulmonary hypoplasia, respiratory depression, respiratory distress syndrome, respiratory failure, respiratory muscle paralysis, sarcoidosis, Shaver's disease, sleep apnea, smoke inhalation, spontaneous pneumothorax, sudden infant death syndrome, suffocation, surfactant metabolism dysfunction, tension pneumothorax, tracheal agenesis without tracheoesophageal fistula, tracheal stenosis, tracheoesophageal fistula, transient tachypnea of the newborn, unilateral pulmonary agenesis, unilateral pulmonary hypoplasia, whooping cough
Renal / Electrolyte Cholesterol emboli syndrome, dehydration, Goodpasture syndrome, hypermagnesemia, hypocalcemia, hypomagnesemia
Rheum / Immune / Allergy Angioneurotic edema, Besnier-Boeck-Schaumann disease, Buergers disease, DiGeorge syndrome, extrinsic allergic alveolitis, Goodpasture syndrome, hypersensitivity pneumonitis, insect sting allergy, laryngeal edema, lupus, neonatal myasthenia gravis, Raynaud's disease, Raynaud's phenomenon, sarcoidosis, Shprintzen syndrome, velocardiofacial syndrome
Sexual Weinstein Kliman Scully syndrome
Trauma Flail chest, head trauma, hemothorax, penetrating chest wounds, shaken baby syndrome, thermal injury,
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Choking, drowning, hanging, high altitude, hypothermia, immobility

Causes in Alphabetical Order

Causes of Cyanosis Based on Classification

Causes of Central Cyanosis

Causes of Peripheral Cyanosis

References

  1. ↑ DiMaio AM, Singh J (October 1992). "The infant with cyanosis in the emergency room". Pediatr. Clin. North Am. 39 (5): 987–1006. PMID 1523025.
  2. ↑ Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.
  3. ↑ Frank DB, Hanna BD (April 2015). "Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics". Minerva Pediatr. 67 (2): 169–85. PMC 4382100. PMID 25604592.
  4. ↑ Izraelit A, Ten V, Krishnamurthy G, Ratner V (2011). "Neonatal cyanosis: diagnostic and management challenges". ISRN Pediatr. 2011: 175931. doi:10.5402/2011/175931. PMC 3317242. PMID 22482063.
  5. ↑ Serino G, Giacomazzi F (2010). "[Pulmonary arterial hypertension in adult patients with congenital heart disease]". Pediatr Med Chir (in Italian). 32 (6): 274–9. PMID 21462449.
  6. ↑ Curry S (April 1982). "Methemoglobinemia". Ann Emerg Med. 11 (4): 214–21. PMID 7073040.
  7. ↑ Ash-Bernal R, Wise R, Wright SM (September 2004). "Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals". Medicine (Baltimore). 83 (5): 265–73. PMID 15342970.
  8. ↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)

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