Sandbox:Chandra

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

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.

Central Cyanosis:

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

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, hydrogen sulphide)
Decresed atmospheric pressure: 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 retrognathia (eg, Pierre-Robin syndrome)
- Neurologic abnormalities:
  - CNS depression
  - Severe head trauma
  - Apnea of prematurity
  - Infections (eg, meningitis, encephalitis)
  - Intraventricular hemorrhage
  - 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
- Alveolar capillary dysplasia
- emphysema or COPD
- Pulmonary edema
- Pulmonary hypoplasia
- Pulmonary hemorrhage
- 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
    - Tricuspid valve anomalies:
    - Pulmonary stenosis (critical valvular)
    - Pulmonary atresia with intact ventricular septum
  - 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:
    - Left sided obstructive lesion (HLHS)
    - Coarctation of aorta
    - Critical valvular aortic stenosis
- 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)

Peripheral Cyanosis:

There following are some of the Common causes of Peripheral Cyanosis: ^[9] ^[10]

Various conditions that cause central cyanosis can also cause peripheral cyanosis.
Cold exposure
Decreased cardiac output (Left sided heart failure, shock or hypovolemia)
Acrocyanosis
Raynaud's phenomenon
Arterial obstruction (Peripheral vascular disease)
Venous obstruction (Thromboembolism)
Redistribution of blood flow from extremities

Life Threatening Causes

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

↑ DiMaio AM, Singh J (October 1992). "The infant with cyanosis in the emergency room". Pediatr. Clin. North Am. 39 (5): 987–1006. PMID 1523025.
↑ Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.
↑ 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.
↑ 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.
↑ 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.
↑ Curry S (April 1982). "Methemoglobinemia". Ann Emerg Med. 11 (4): 214–21. PMID 7073040.
↑ 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.
↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)
↑ Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH (2016). "Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms". Front Pharmacol. 7: 438. doi:10.3389/fphar.2016.00438. PMC 5110514. PMID 27899893.
↑ Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.

[pmid1523025-1] DiMaio AM, Singh J (October 1992). "The infant with cyanosis in the emergency room". Pediatr. Clin. North Am. 39 (5): 987–1006. PMID 1523025.

[pmid2407997-2] Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.

[pmid25604592-3] 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.

[pmid22482063-4] 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.

[pmid21462449-5] 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.

[pmid7073040-6] Curry S (April 1982). "Methemoglobinemia". Ann Emerg Med. 11 (4): 214–21. PMID 7073040.

[pmid15342970-7] 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.

[pmid28722923-8] Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)

[pmid27899893-9] Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH (2016). "Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms". Front Pharmacol. 7: 438. doi:10.3389/fphar.2016.00438. PMC 5110514. PMID 27899893.

[pmid24249890-10] Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.

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Sandbox:Chandra

Causes

Central Cyanosis:

Peripheral Cyanosis:

Life Threatening Causes

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