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Bruit

Exams and Signs

Historical Overview

  • Bruit is from the French word braire, to bray or roar. It refers to sounds heard from blood vessels.1

Description

  • A bruit occurs when there is acceleration in the velocity of blood in the circulation, which produces acoustic vibrations.2
  • In most cases, a bruit heard over an aneurysm indicates disruption of normal laminar blood flow in that or a nearby artery.1

Pathophysiology

  • A bruit may arise from vaso-occlusive disease, atherosclerotic disease or upper extremity arterial aneurysm.
  • “Innocent” thoracic bruits, not indicating pathology, may be heard in some patients from childhood through their mid-30s.1

Instructions

  1. Obtain an accurate and complete patient history3
  2. In a quiet room, apply gentle pressure with a stethoscope to listen for the sounds of turbulent blood flow
  3. If a bruit is heard during the auscultation, assess the volume, pitch and duration
  4. The sound created by an upper extremity arterial aneurysm that may produce a bruit can also be identified using Doppler

Variations

  • Also check for thrills, or palpable vibratory sensations, over a vessel in which a bruit is heard. In these situations, a Doppler exam would be indicated.

Related Signs and Tests

  • Radial artery pulse
  • Ulnar artery pulse
  • Allen test
  • Doppler

Diagnostic Performance Characteristics

  • Related tests should be carried out in conjunction with the bruit test. Bruits associated with arterial stenosis are not usually heard until an artery is ≥50% occluded.4
Presentation Photos and Related Diagrams
Auscultation of Bruit
  • Stethoscope auscultating ulnar artery aneurysm (arrow) for a bruit
    Stethoscope auscultating ulnar artery aneurysm (arrow) for a bruit
Definition of Positive Result
  • A positive result occurs when a loud whistling sound of turbulent blood flow is detected.
Definition of Negative Result
  • A negative result occurs when the blood vessels do not make any irregular sound.
Comments and Pearls
  • A bruit of longer duration or changed pitch may indicate a progression of stenosis.
  • If a thrill is palpated during the examination, it may indicate significant vascular pathology.4
Diagnoses Associated with Exams and Signs
References
  1. Loscalzo J, Creager MA, Dzau VJ eds. Vascular Medicine. Boston: Little, Brown and Company, 1996.
  2. Abramson, DI. Vascular Disorders of the Extremities. New York: Harper and Row, 1974.
  3. Culp R, Jacoby S.  Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple.  New Jersey: SLACK Incorporated, 2012.
  4. Walker HK, Hall WD, Hurst JW eds. Clinical Methods: The History, Physical and Laboratory Examinations. 3rd edition. Boston: Butterworths, 1990.
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