The diagnoses most frequently to be considered when a newborn infant is found to have heart failure and cyanosis include congenital lesions of the heart shunting unoxygenated blood to the systemic circuit. Less frequently seen are primarily acyanotic lesions that cause cyanosis by virtue of the left heart failure they engender.1 The recent literature contains several case reports of infants whose failure was due to large intracranial arteriovenous fistulae, but these were acyanotic until severe left heart failure developed.2-12
We have recently observed a newborn boy with heart failure caused by an intracranial arteriovenous fistula, but who had cyanosis when he was in only moderate failure. Investigations revealed methemalbumin discoloring his plasma, and bilateral subdural hematomas. As the chocolate-colored fluid was removed from the subdural spaces, both his cyanosis and the plasma pigment cleared, without a significant change in his cardiac status.
Report of Case
A Caucasian boy
NEWCOMB R, LIEBMAN J, COLLINS W, SHOJANIA AM. Cyanosis Caused by MethemalbuminemiaReport of a Case in a Newborn With Intracranial Arteriovenous Fistula, Congestive Heart Failure, and Subdural Hematomas. Am J Dis Child. 1963;106(5):507–513. doi:10.1001/archpedi.1963.02080050509021