Central cyanosis, dyspnea, and fever

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Abbreviations: ABG= Arterial blood gas, ANP= Atrial natriuretic peptide, BNP= Brain natriuretic peptide, CBC= Complete blood count, COPD= Chronic obstructive pulmonary disease, CRP= C-reactive protein, CT= Computed tomography, CXR= Chest X-ray, DVT= Deep vein thrombosis, ESR= Erythrocyte sedimentation rate, HRCT= High Resolution CT, IgE= Immunoglobulin E, LDH= Lactate dehydrogenase, PCWP= Pulmonary capillary wedge pressure.

Diseases Cyanosis Clinical manifestations Para-clinical findings Gold standard Additional findings
Symptoms Physical examination
Lab Findings Imaging
Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation CBC ABG Electrolytes Other X-ray CT scan Other
Pulmonary diseases Airway disorder Chronic bronchitis[1] - + + +/- +/- + - Rales, crackles, Wheeze Leukocytosis ↓O2, ↑CO2, Respiratory acidosis Hypokalemia, Hypernatremia Gram stain of sputum Elongated heart, Flattened diaphragms, Prominent hilar vasculature Bronchial wall thickening with increased bronchovascular markings - HRCT Productive cough, Chest tightness
Parenchymal disorder Alveolitis[2] +/- + + + + +/- - Wheeze, Crackles Leukocytosis, Eosinophilia ↓O2, ↑CO2 Normal ↑ESR, ↑CRP Scattered opacities, Fine reticulation Homogeneous ground-glass opacity - HRCT PLUS Clinical findings Malaise, Chills, Headache
Pneumonia[3] - + + + + +/- - Rales, Crackles, Wheeze, Pleural friction rub Leukocytosis with neutrophilia Normal Hyponatremia - Entire lobe consolidated, Air bronchograms Focal ground-glass opacity - HRCT Tachycardia, Bradycardia (Legionella)
Tuberculosis[4] - + + + + +/- - Reduced breath sounds, Wheeze, Inspiratory crackles Leukocytosis, ↑Lymphocyte ↓O2, ↑CO2 Hyponatremia, Hyperkalemia, Hypochloremia PPD, interferon-gamma release assay (IGRA) Dense, homogeneous parenchymal consolidation Nodules with low-density centers and rim enhancement Fluorodeoxyglucose positron emission tomography/CT (FDG PET/CT) Sputum culture, QuantiFERON-TB Gold (QFT) Loss of appetite, Night sweats
Acute respiratory distress syndrome[5] - + + +/- + - - Inspiratory crackles Leukopenia/Leukocytosis ↓O2, ↓CO2, Respiratory alkalosis Hyponatremia, Hyperkalemia ↑BNP, ↑Von Willebrand factor (VWF) Bilateral pulmonary infiltrates (patchy to diffuse) Emphysema, Pneumothorax and pneumomediastinum, Mediastinal lymphadenopathy Invasive Hemodynamic Monitoring (PCWP), Bronchoscopy Chest CT scan Tachypnea, Muscle weakness
Cardiac diseases Acquired disorders Myocardial infarction[6] - + + +/- + - - S3 and S4 Normal Normal Hyponatremia, Hypokalemia Elevated troponin I and CKMB Rolling out other causes Coronary luminal narrowing in CT perfusion scan Wall motion abnormality in echocardiography Cardiac troponin I Dizziness, Fatigue, Lightheadedness, Cold sweat
Hematologic diseases Methemoglobinemia[7] - + + +/- + - - Wheezing Anemia, Methemoglobinemia Normal PaO2, ↑SaO2, "Saturation gap" Normal ↓SaO2 in pulse oximetry Normal Normal Echocardiography for ruling out other causes Co-oximetry, ABG paired with pulse oximetry. Serum methemoglobin levels Headache, Altered mental status, Delirium, Seizure, Coma
Polycythemia[8] + + + +/- +/- + - Normal ↑RBC, ↑WBC, ↑HGB, ↑Plt ↓O2 Hyperkalemia ↑Leukocyte alkaline phosphatase, ↑Ferritin, ↑Erythropoietin AVM, COPD, pulmonary hypertension Normal Abdominal ultrasound or renal vascular studies for ruling out renal artery stenosis RBC mass (RCM) and plasma volume measurement Itchiness, Headache. Dizziness. Blurred vision
Neurological disease Seizure[9] - + + +/- - - - Normal Normal ↓O2, ↑CO2 Hyponatremia, Hypo/Hypercalcemia ↑CPK, ↑LDH, Normal Normal EEG EEG Fainting, Tonic-clonic movements

References

  1. ↑ Kim V, Criner GJ (2013). "Chronic bronchitis and chronic obstructive pulmonary disease". Am J Respir Crit Care Med. 187 (3): 228–37. doi:10.1164/rccm.201210-1843CI. PMC 4951627. PMID 23204254.
  2. ↑ Lee JS, Im JG, Ahn JM, Kim YM, Han MC (August 1992). "Fibrosing alveolitis: prognostic implication of ground-glass attenuation at high-resolution CT". Radiology. 184 (2): 451–4. doi:10.1148/radiology.184.2.1620846. PMID 1620846.
  3. ↑ Simonetti AF, Viasus D, Garcia-Vidal C, Carratalà J (2014). "Management of community-acquired pneumonia in older adults". Ther Adv Infect Dis. 2 (1): 3–16. doi:10.1177/2049936113518041. PMC 4072047. PMID 25165554.
  4. ↑ Olalekan, Adebimpe Wasiu; Oluwaseun, Faremi Ayodeji; Oladele, Hassan Abdul-Wasiu; Akeem, Adeyemi Damilare (2015). "Evaluation of electrolyte imbalance among tuberculosis patients receiving treatments in Southwestern Nigeria". Alexandria Journal of Medicine. 51 (3): 255–260. doi:10.1016/j.ajme.2014.10.003. ISSN 2090-5068.
  5. ↑ Ochiai R (2015). "Mechanical ventilation of acute respiratory distress syndrome". J Intensive Care. 3 (1): 25. doi:10.1186/s40560-015-0091-6. PMC 4456061. PMID 26045965.
  6. ↑ "Myocardial Infarction (Heart Attack): Symptoms - National Library of Medicine - PubMed Health".
  7. ↑ Ashurst J, Wasson M (July 2011). "Methemoglobinemia: a systematic review of the pathophysiology, detection, and treatment". Del Med J. 83 (7): 203–8. PMID 21954509.
  8. ↑ Spivak JL (February 2002). "The optimal management of polycythaemia vera". Br. J. Haematol. 116 (2): 243–54. PMID 11841424.
  9. ↑ Goldenberg MM (2010). "Overview of drugs used for epilepsy and seizures: etiology, diagnosis, and treatment". P T. 35 (7): 392–415. PMC 2912003. PMID 20689626.
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