Two Unusual Cases of Cyanosis in Infants

Abstract

The common causes of severe cyanosis in young infants are congenital heart disease and atelectasis. The clinical differentiation between the two conditions is not always easy, and the following cases are good illustrations of the value of radiography in arriving at an exact diagnosis. A female child admitted to hospital at the age of four months for “blueness” and a discharge from the ear. The child had been delivered normally at full term. It was not cyanosed at birth, but after 14 days became blue and remained so. It was breast-fed for a month and appeared to be thriving until the fifth or sixth week. On examination, the child was much under normal weight for its age and moderately cyanosed. There was no clubbing of the fingers and no deformities of the skull, mouth, spine or limbs. Respiration was rather rapid, but it cried well and fed well. The cyanosis increased at times, but especially during feeding or crying. A loud systolic murmur could be heard all over the heart. The breath sounds were normal. An electrocardiograph showed right preponderance. X-ray examination showed marked enlargement of the heart to right and left of the middle line. The widest point of the heart shadow on either side was rounded and well-defined, giving the impression of an apex on each side. The aorta could not be defined. The pulmonary artery was not dilated and there was no hyperæmia of the lungs. On the screen, both borders of the heart pulsated synchronously.