Definition

Acute arterial thrombosis of the right leg

Cyanosis is defined as a bluish discoloration, especially of the skin and mucous membranes due
to excessive concentration of deoxyhemoglobin in the blood.

Differential diagnosis
Cyanosis is divided in to two main types: central (around the core and lips) and peripheral (only
the extremities are affected). Cyanosis can occur in the fingers, including underneath the
fingernails, as well as other extremities (called peripheral cyanosis), or in the lips and tongue
(central cyanosis).

Central cyanosis
Central cyanosis is often due to a circulatory or ventilatory problem that leads to poor blood
oxygenation in the lungs. It develops when arterial saturation of blood with oxygen is 85%.
Cyanosis may not be detected until saturation is 75% in dark-skinned individuals.
Acute cyanosis can be a result of asphyxiation or choking, and is one of the surest signs that
respiration is being blocked.
Causes
1. Central Nervous System:

Intracranial hemorrhage
Cerebral anoxia

Drug overdose (e.g. Heroin)

2. Respiratory System:

Bronchiolitis
Bronchospasm (e.g. Asthma)

Lung disease

Pulmonary Hypertension

Pulmonary embolism

Hypoventilation

COPD (emphysema and chronic bronchitis)

Respiratory syncytial virus

3. Cardiac Disorders:

Congenital heart disease (e.g. Tetralogy of Fallot, Right to left shunts in heart or great
vessels)
Heart failure

Heart valve disease

Myocardial infarction

4. Blood:

Methemoglobinemia
Polycythaemia

5. Others:

High altitude
Hypothermia

Congenital cyanosis (HbM Boston) arises from a mutation in the -codon which results
in a change of primary sequence, H Y. Tyrosine stabilises the Fe(III) form
(oxyhaemoglobin) creating a permanent T-state of Hb.

Obstructive sleep apnea

Peripheral cyanosis
Peripheral cyanosis is the blue tint in fingers or extremities, due to inadequate circulation. The
blood reaching the extremities is not oxygen rich and when viewed through the skin a
combination of factors can lead to the appearance of a blue color. All factors contributing to
central cyanosis can also cause peripheral symptoms to appear, however peripheral cyanosis can
be observed without there being heart or lung failures. Small blood vessels may be restricted and
can be treated by increasing the normal oxygenation level of the blood.
Causes

All common causes of central cyanosis

Arterial obstruction

Cold exposure (due to vasoconstriction)

Raynaud's phenomenon (vasoconstriction)

Reduced cardiac output (e.g. heart failure, hypovolaemia)

Vasoconstriction

Venous obstruction (e.g. deep vein thrombosis)

Differential cyanosis
Differential cyanosis is the bluish coloration of the lower but not the upper extremity and the
head. This is seen in patients with a patent ductus arteriosus. Patients with a large ductus develop
progressive pulmonary vascular disease, and pressure overload of the right ventricle occurs. As
soon as pulmonary pressure exceeds aortic pressure, shunt reversal (right-to-left shunt) occurs.
The upper extremity remains pink because the brachiocephalic trunk, left common cartoid trunk
and the left subclavian trunk is given off proximal to the PDA.