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

Differential diagnosis

Abbreviations: COPD= Chronic obstructive pulmonary disease,

Causes of cyanosis Disease Cyanosis Clinical manifestations/association Diagnosis Additional

findings

Symptoms Signs
Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard
Respiratory Airway

disorder

Croup + +
Epiglottitis +
Foreign body aspiration + +
Airway trauma + + ±
Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard Additional findings
Parenchymal

disorder

Pulmonary embolism
  • ABGs
  • D-dimer
  • Dyspnea
  • Tachycardia
  • Pleuretic chest pain
Pneumonia
  • ABGs
  • Leukocytosis
  • Pancytopenia
  • CXR
  • CT chest
  • Bronchoscopy
  • Shortness of breath
  • Cough
Asthma

(Late)

+
Cystic fibrosis ± ±
COPD

(Emphysema)

± +
Empyema ± + Chest X-ray
  • Pleural opacity
  • Localization of effusion
Physical examination
Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard Additional findings
Chest

wall

disorders

Flail chest ±
Pneumothorax ±
Hemothorax + ±
Cardiovascular Congenital

heart diseases

Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard Additional findings

Atrioventricular canal defect

+ +
Ebstein anomaly
Hypoplastic left heart syndrome
Pulmonary atresia
Tetralogy of Fallot
Pulmonic stenosis
Total anomalous pulmonary venous drainage
Transposition of the great vessels
Truncus arteriosus
Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard Additional findings
Heart failure + + + +

(S3)

  • CBC
  • Complete metabolic profile
  • Cardiac enzymes
  • BNP
  • Thyroid profile
  • Renal function tests
  • EKG
  • Exercise stress test
  • ABG's
  • Lipid profile
  • CXR
    • Increase in heart size compared to the old film.
    • Pleural fluid
    • Interstitial edema
  • Echocardiography
  • Angiography
  • Cardiac MRI
  • Nuclear imaging
  • Endomyocardial biopsy can be used when a specific diagnosis is suspected that would influence therapy in heart failure patients.
Valvular heart disease ± + +
  • CBC
  • Complete metabolic profile
  • Cardiac enzymes
  • BNP
  • Thyroid profile
  • Renal function tests
  • EKG
  • CXR
    • To assess pulomary congestion or other lung pathology.
  • Echocardiography
  • Doppler echocardiography
  • Angiography
    • To assess the need for concomitant coronary artery bypass surgery in elderly people.
Myocardial infarction + + +
  • CBC
  • Complete metabolic profile
  • Cardiac enzymes
  • BNP
  • Thyroid profile
  • Renal function tests
  • EKG
  • Lipid profile
  • CXR
    • Normal or may show signs of CHF
  • Echocardiography
  • Angiography
Central Nervous system Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard Additional findings
Methemoglobinemia +
  • CBC
  • Peripheral smear
  • Complete metabolic profile
  • Hemoglobin electrophoresis
  • Serum nitrite levels
  • Pulse oximetry
  • ABG's
  • Drug screen
  • LDH
Polycythemia + +
  • CBC
  • Pulse oximetry
  • Erythropoietin levels (EPO)
  • ABG's
  • Increased leukocyte alkaline phosphatase
  • B12 levels
  • JAK 2 mutation
  • CXR
Disease Peripheral Central Dyspnea Fever Chest pain Clubbing Peripheral edema Auscultation Lab Findings Imaging Gold standard Additional findings
Breath holding spells
  • No confirmatory study
  • CBC
  • Serum ferritin
  • Blood lead level
  • video-EEG monitoring can be use in non diagnostic cases.
  • Cyanotic breath-holding spells most commonly occur around 1 year of age with a range of six months to four years.
  • Iron deficiency anemia is more prevalent in children with breath-holding spells. 
Miscellaneous Shock + + (septic shock) + + (Cardiogenic shock)
  • Complete metabolic profile
  • CBC
  • Cardiac enzymes
  • ABG's
  • Lactate
  • BNP
  • Renal function tests
  • Coagulation studies and D-dimer level
  • Echocardiography
  • Chest radiography
  • Angiography
Smoke inhalation + + +
  •  CBC

Electrolytes

BUN and CR,

Lactate levels

Toxicology screen

CO-oximetry 

    • CXR
    • ECG
    • Serial cardiac enzymes (in patients with chest pain)\
    • Pulmonary function testing
    • Direct laryngoscopy and fiberoptic bronchoscopy
  • CO toxicity should be suspected in any patient who presents following smoke inhalation unless co-oximetry shows normal carboxyhemoglobin.
Cold exposure
  • Fingerstick glucose (Hyperglycemia)
  • Electrocardiogram (ECG) may show J wave, sinus bradycardia and prolongation of all ECG intervals.
  • Serum electrolytes (including potassium and calcium)
  • BUN and creatinine
  • Serum hemoglobin, white blood cell, and platelet counts ( Raised HCT due to volume contraction)
  • Coagulation profile (clotting factors impairment)
  • Serum lactate ( lactic acidosis)
  • Creatine kinase (Rhabdomylosis)
  • Arterial blood gas
  • CXR
  • Mild hypothermia: core temperature 32 to 35°C ; patient presents with confusion, tachycardia, and increased shivering.
  • Moderate hypothermia: 28 to 32°C patient presents with lethargy, bradycardia and arrhythmia and decreased shivering.
  • Severe hypothermia: below 28°C patient presents with coma, hypotension, arrhythmia, pulmonary edema, and rigidity.