Differential Clubbing and Cyanosis: Classic Signs of Patent Ductus Arteriosus With Eisenmenger Syndrome  Sunil Kumar Srinivas, MD, Cholenahally Nanjappa Manjunath, MD, DM  Mayo Clinic Proceedings  Volume 88, Issue 9, Pages e105-e106 (September 2013) DOI: 10.1016/j.mayocp.2013.02.016 Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions

Figure A, Clubbing and cyanosis of the toes but not the fingers in a patient with congenital heart disease. B, Electrocardiogram showed sinus rhythm with a rightward axis and right ventricular hypertrophy. C, Chest radiograph revealed a dilated main pulmonary artery (MPA) and right descending pulmonary artery (RDPA), with right ventricular (RV) apex. D, Two-dimensional echocardiogram revealed a large patent ductus arteriosus (arrow). E, Echocardiogram showed predominant right-to-left shunting. F, Contrast echocardiogram confirmed the right to left shunting across the patent ductus arteriosus (arrow). Mayo Clinic Proceedings 2013 88, e105-e106DOI: (10.1016/j.mayocp.2013.02.016) Copyright © 2013 Mayo Foundation for Medical Education and Research Terms and Conditions