Cyanosis: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing).
      • Skin, central mucous membranes, and sclerae (white part of the eye) [cyanosis (bluish discoloration of skin and/or central mucous membranes):
        • Central cyanosis* – bluish discoloration of skin and central mucous membranes (tongue).
        • peripheral cyanosis* – blue discoloration of the lips and the acras (finger/toe extremities, nose, ears); in contrast, the central mucous membranes are rosy!
          • Generalized (e.g., in heart failure/heart failure).
          • Localized (e.g., in phlebothrombosis/thrombotic occlusion of deep veins)]
    • Auscultation (listening) of the heart [valvular vitium/valvular fheler?]
    • Examination of the lungs
      • Auscultation (listening) of the lungs
      • Bronchophony (checking the conduction of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the physician listens to the lungs) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g. in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in case of decreased sound conduction (attenuated or absent): e.g. in pleural effusion, pneumothorax, emphysema). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
      • Percussion (tapping) of the lungs [eg. E.g. hypersonoric tapping sound in bronchial asthma, emphysema; box tone in pneumothorax]
      • Vocal fremitus (testing of low frequency conduction; patient is asked to say the word “99” several times in a low voice while the physician places his hands on the patient’s chest or back) [increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g. e.g., pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; with decreased sound conduction (attenuated: e.g., atelectasis, pleural rind; severely attenuated or absent: with pleural effusion, pneumothorax, emphysema). The result is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]

* Lewis test – even when massaging the earlobe, it remains cyanotic in central cyanosis; in peripheral cyanosis, the earlobe becomes rosy.

Square brackets [ ] indicate possible pathological (pathological) physical findings.