Hand Surgery Source

Bruit

Test, Exam 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 Tests, 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.