Fig. 21.1
Schematic showing the structural anomalies in this infant leading to reverese differential cyanosis. Blue represents deoxygenated blood, and red oxygenated blood. RA right atrium, RV right ventricle, LA left atrium, LV left ventricle, Ao aorta, PA pulmonary artery, DA ductus arteriosus, CoA coarctation of the aorta, VSD ventricular septal defect
Reverse differential cyanosis may be an under-recognised sign of critical heart disease. Depending on the underlying pathology, neonates may initially appear well with no murmur and with normal femoral pulses.
Learning Points
Reverse differential cyanosis may be commoner than recognised. It should not be ignored, and critical cardiac lesions should be ruled out as a priority.
Screening programmes which measure only post-ductal saturations may miss many of these cases
Normal four-limb blood pressure measurements cannot rule out coarctation of the aorta
Assessment of femoral pulse strength is subjective. Clinicians should have a high index of suspicion when femoral pulses are difficult to identify.< div class='tao-gold-member'>Only gold members can continue reading. Log In or Register to continue
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