Duroziez’s Sign

A 68-year-old man presented with a 3-month history of exertional dyspnea and leg edema. The vital signs were normal except for a blood pressure of 142/42 mmHg. During blood pressure measurement, a short, loud, snapping (or “pistol shot”) sound was heard with the stethoscope placed lightly on the brachial artery. In addition, when the diaphragm of the stethoscope was slowly pressed on the femoral artery, a new diastolic murmur developed (Figure A; Supplementary Sound). This phenomenon is known as Duroziez’s sign,¹ which, when properly performed, has been reported to be almost 100% specific and 90% sensitive for the diagnosis of pure aortic regurgitation.² Pulsed-wave color Doppler ultrasound showed that the newly developed murmur was the result of retrograde diastolic blood flow in the femoral artery (Figure B,C).

Figure.

(A) A phonogram obtained near the left femoral artery showed a systolic murmur in the first beat, followed by noise due to increased compression force in the second beat, and a new diastolic murmur on the higher-middle and high frequencies in the third beat (arrows). (B,C) Pulsed-wave color Doppler ultrasound showed an increase in diastolic backward flow in the femoral arterial blood with compression (arrow), accompanied by diastolic murmurs (arrowhead).

The patient’s physical examination was also notable for the rapid rise and quick collapse of the carotid artery (i.e., Corrigan’s pulse), rhythmic movements of the head (i.e., de Musset’s sign), alternating flushing and blanching of the nail beds (i.e., Quincke’s pulse), and a low-pitched diastolic rumble at the apex (i.e., Austin Flint murmur). A diagnosis of severe aortic regurgitation was made by echocardiography. The patient underwent surgical aortic valve replacement, and these physical findings completely disappeared after surgery.

Disclosures

None declared.

Supplementary Files

Supplementary File 1

Supplementary Sound