Question:medium

Differential cyanosis (pink upper limbs with cyanosed lower limbs) is characteristically seen in:

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Blue legs, pink arms means desaturated blood enters the aorta distal to the subclavian via a duct.
Updated On: Jun 25, 2026
  • Patent ductus arteriosus (PDA) with reversal of shunt / Eisenmenger
  • Osler-Weber-Rendu syndrome
  • Peripheral arterial disease
  • Transposition of great arteries (simple)
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The Correct Option is A

Solution and Explanation

The hallmark of differential cyanosis is a split colour: the head and right upper limb stay pink while the legs turn blue. Anatomically this can only happen when desaturated blood enters the aorta beyond the origin of the head-and-arm vessels.

A large patent ductus arteriosus that has developed pulmonary hypertension does exactly this. Once pulmonary pressure exceeds systemic ($Eisenmenger$ reversal), venous blood in the pulmonary artery shunts through the duct into the descending aorta:
\[ \text{Pulmonary artery} \xrightarrow{\text{PDA, R}\to\text{L}} \text{Descending aorta (post-subclavian)} \]
Thus the lower body is perfused with deoxygenated blood (cyanosis, clubbing of toes) while pre-ductal vessels keep the upper body pink.

Osler-Weber-Rendu produces telangiectasias and AVMs, peripheral arterial disease produces ischaemic acrocyanosis, and uncomplicated transposition gives global cyanosis - none reproduce this gradient.

\[\boxed{\text{PDA with Eisenmenger (right-to-left) shunt}}\]
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