She had both peripheral and central cyanosis
in the absence of clubbing.
Classic barrel chest, central cyanosis
, pursed-lip breathing, or signs of right heart failure may be seen on exam.
MetHb Clinical concentration (%) findings 10-20 Central cyanosis
of limbs/trunk 20-45 Central nervous system depression (headache, dizziness, fatigue, lethargy), dyspnea 45-55 Coma, arrhythmias, shock, convulsions > 60 High risk of mortality Adapted from Kross et al.
(cyanosis affecting the inner portion of the lips, the tongue, and the nail beds) is often seen with pathologic heart murmurs.
(%) Symptoms Fever 53 (96) Vomiting 35 (64) Poor feeding 27 (49) Dyspnes 23 (42) Increased sleepiness 17 (31) Cough 14 (26) Irritability 11 (20) Generalized weekness 14 (26) Diarrhes 7 (13) Rhinorrhes 6 (11) Signs Skin/Mueous membrane Hand or foot rash 32 (58) Mouth unclers 28 (51) Herpangina 8 (15) Respiratory Rales 26 (48) Rhonchi 21 (39) Retractions 17 (32) Cardiac Central cyanosis
28 (52) Peripheral cyanosis 22 (41) Neurologic Somnolent or lethargic 24 (44) Comatose 13 (24) Alert 9 (17) Nuchal rigidity 7 (13) Seizure 7 (13) Focal paralysis or weakness 1 ( 2) (*.)N=55.
However, our retrospective data showed that a high amount of SulfHb was clearly present, in concentrations sufficient to cause the central cyanosis
observed on admission.
We present a similar case in a 31-year old male who came in with orthopnoea, central cyanosis
and pedal oedema.
Pulmonary artery dissection symptoms are nonspecific, and 82% of patients have exertional dyspnea, 67% have retrosternal chest pain, and 52% have central cyanosis
None of the babies in our study, even when they had SpO2 values well below 90%, were observed to have central cyanosis
by the team of investigators, a finding also supported by other studies.
It was thought that the patient might have pulmonary arteriovenous malformation or fistula because of presence of central cyanosis
, recurrent epistaxis and telengiectasies on the face, absence of pathology in the heart and exclusion of methemoglobinemia.
Fine inspiratory crackles was the most common physical sign present in 49 patients (98%), wheeze in 30 patients (60%), finger clubbing in 19 patients (38%), ankle odema in 11 patients (22%) central cyanosis
in 10 patients (20%), raised jugular venous pressure in 8 patients (16%) and skin lesions in 4 patients (8%) (Figure 1).
On physical examination, the patient has central cyanosis
, pretibial edema and her lung sounds were decreased to auscultation bilaterally with deep inspiration.