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| ====Central cyanosis:==== | | ====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> | | There following are some of the common causes of central cyanosis: |
| *'''Conditions associated with decreased concentration of inspired oxygen (FiO2):''' | | *'''Conditions associated with decreased concentration of inspired oxygen (FiO2):''' |
| **[[Smoke inhalation]] most commonly from house fires | | **[[Smoke inhalation]] most commonly from house fires |
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| **Hanging | | **Hanging |
| **[[Hypothermia]] | | **[[Hypothermia]] |
| | ====Peripheral Cyanosis:==== |
| | There following are some of the Common causes of Peripheral Cyanosis: <ref name="pmid27899893">{{cite journal |vauthors=Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH |title=Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms |journal=Front Pharmacol |volume=7 |issue= |pages=438 |date= 2016 |pmid=27899893 |pmc=5110514 |doi=10.3389/fphar.2016.00438 |url= |author=}}</ref> <ref name="pmid24249890">{{cite journal |vauthors=Das S, Maiti A |title=Acrocyanosis: an overview |journal=Indian J Dermatol |volume=58 |issue=6 |pages=417–20 |date=November 2013 |pmid=24249890 |pmc=3827510 |doi=10.4103/0019-5154.119946 |url= |author=}}</ref> |
| | *Various conditions that cause central cyanosis can also cause peripheral cyanosis. |
| | **[[Asthma]] |
| | **[[Emphysema]] |
| | **[[Chronic obstructive pulmonary disease]] |
| | **[[Congenital heart disease]] |
| | **[[Tetralogy of fallot]] |
| | **[[Heart failure]] |
| | **[[High altitude]] |
| | **[[Methemoglobinemia]] |
| | **[[Polycythemia vera]] |
| | **[[Pulmonary embolism]] |
| | *[[Hypothermia|Cold exposure]] |
| | *Decreased cardiac output |
| | **[[Congestive heart failure|Left sided heart failure]] |
| | **[[shock]] |
| | **[[hypovolemia]] |
| | *[[Acrocyanosis]] |
| | *[[Erythrocyanosis]] |
| | *[[Raynaud's phenomenon]] |
| | *[[Raynaud's disease]] |
| | *[[Buergers disease]] |
| | *Arterial obstruction [[Peripheral arterial disease|(Peripheral vascular disease]]) |
| | *Venous obstruction ([[Thromboembolism]], [[Deep vein thrombosis]]) |
| | *Redistribution of blood flow from extremities |
| | |
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| ===Life Threatening Causes=== | | ===Life Threatening Causes=== |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]; Ogheneochuko Ajari, MB.BS, MS [3]
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:
- Conditions associated with decreased concentration of inspired oxygen (FiO2):
- Impairment of chest wall or lung expansion:
- Hypoventilation:
- Upper airway obstruction:
- Neurologic abnormalities:
- Neuromuscular disorders:
- Myasthenia gravis
- Injury to the phrenic nerve
- Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
- Metabolic disorders:
- Ventilation/perfusion mismatch:
- Conditions causing impaired oxygen diffusion:
- Intrinsic lung diseases:
- Vascular causes:
- Cyanotic congenital heart diseases (Right to left shunts):
- Decreased pulmonary flow:
- Increased pulmonary flow:
- TGA (Transposition of great arteries, most common dextro type)
- Truncus arteriosus
- TAPVC (Total anamalous pulmonary venous connection)
- Heart failure: Condition that present with cyanosis and severe heart failure include:
- Eisenmenger syndrome
- Pulmonary causes:
- Shock
- Sepsis
- Hematologic abnormalities:
- Miscellaneous:
Peripheral Cyanosis:
There following are some of the Common causes of Peripheral Cyanosis: [1] [2]
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
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
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