Symptom Finder - Cervical Bruit
CERVICAL BRUIT
Anatomy is the key to the differential diagnosis of a cervical bruit. Visualizing the neck, we have the carotid, innominate, and subclavian arteries; the jugular, innominate, and subclavian veins; the thyroid, scalenus anticus muscle, and cervical ribs, all of which may be involved in this sign.
Arteries: This should prompt the recall of a carotid or subclavian artery stenosis (subclavian steal syndrome) or an aneurysm. It should also remind us of aortic murmurs that may be transmitted to the neck from a stenosed aortic valve, calcific aortitis, or an aortic aneurysm.
Veins: A venous hum may be heard in the neck as a result of a circuitous route that blood must take in the veins. This is of course usually benign.
Thyroid: This prompts the recall of the bruit heard over the thyroid in Graves disease.
Muscles: Occasionally a bruit is heard in the neck in patients with scalenus anticus syndrome or other forms of thoracic outlet syndrome.
Cervical rib: The subclavian artery may also be compressed by a cervical rib producing a cervical bruit.
Approach to the Diagnosis
A history of diaphoresis, weight loss, or heat intolerance would arouse suspicion of hyperthyroidism. A history of transient hemiplegia, amaurosis fugax, or other intermittent neurologic symptomatology should point to a carotid stenosis or subclavian steal syndrome. Physical findings of pallor or spoon nails would point to anemia. An enlarged thyroid prompts the suspicion of hyperthyroidism. If there is a diminished pulse on the side of the bruit, look for thoracic outlet syndrome or subclavian steal syndrome. The diagnostic workup may need to include a CBC, thyroid panel, and carotid duplex scan.
Consult a neurologist if there are objective neurologic signs. Four-vessel angiography needs to be considered if a carotid stenosis or subclavian steal syndrome is suspected. If the bruit seems to be transmitted from the chest, echocardiography may be needed.
Anatomy is the key to the differential diagnosis of a cervical bruit. Visualizing the neck, we have the carotid, innominate, and subclavian arteries; the jugular, innominate, and subclavian veins; the thyroid, scalenus anticus muscle, and cervical ribs, all of which may be involved in this sign.
Arteries: This should prompt the recall of a carotid or subclavian artery stenosis (subclavian steal syndrome) or an aneurysm. It should also remind us of aortic murmurs that may be transmitted to the neck from a stenosed aortic valve, calcific aortitis, or an aortic aneurysm.
Veins: A venous hum may be heard in the neck as a result of a circuitous route that blood must take in the veins. This is of course usually benign.
Thyroid: This prompts the recall of the bruit heard over the thyroid in Graves disease.
Muscles: Occasionally a bruit is heard in the neck in patients with scalenus anticus syndrome or other forms of thoracic outlet syndrome.
Cervical rib: The subclavian artery may also be compressed by a cervical rib producing a cervical bruit.
Approach to the Diagnosis
A history of diaphoresis, weight loss, or heat intolerance would arouse suspicion of hyperthyroidism. A history of transient hemiplegia, amaurosis fugax, or other intermittent neurologic symptomatology should point to a carotid stenosis or subclavian steal syndrome. Physical findings of pallor or spoon nails would point to anemia. An enlarged thyroid prompts the suspicion of hyperthyroidism. If there is a diminished pulse on the side of the bruit, look for thoracic outlet syndrome or subclavian steal syndrome. The diagnostic workup may need to include a CBC, thyroid panel, and carotid duplex scan.
Consult a neurologist if there are objective neurologic signs. Four-vessel angiography needs to be considered if a carotid stenosis or subclavian steal syndrome is suspected. If the bruit seems to be transmitted from the chest, echocardiography may be needed.
