Value and Limits of "Critical Auscultation" of Neck Bruits

Abstract

Within a group of 2,000 patients evaluated, most of them with symptoms of cerebrovascular insufficiency, 441 had a monolateral or bilateral cervical bruit. The 627 sides with an audible bruit were divided into main groups (A) symptomatic (TIA and/or stroke homolateral to the bruit), (B) possibly symptomatic (non-side-related symptoms), (C) asymptomatic (C1, in totally asymptomatic patients; C2, in patients with symptoms dependent on the hemisphere contralateral to the cervical bruit). Each patient was studied by means of clinical (history, blood pressure in both upper limbs, phonoendoscopic auscultation at various levels) and noninvasive instrumental examinations (CW Doppler spectrum analysis). An apparently primitive cervical bruit corresponded to a lesion of the carotid bifurcation in 61% of the cases (positive predictive value) whereas a normal bifurcation was detected in 70% of the cases in which the cervical bruit was considered as secondary (negative predictive value); the diagnostic accuracy of the "critical auscultation" has a value therefore of 63%, with a sensitivity of 84% and a specificity of 40%. The results obtained in the different groups of patients (symptomatic or asymptomatic) were not significantly different (chi-square). Even though maintaining the value of a cervical bruit as a sign of carotid stenosis or occlusion and consequently confirming the importance of neck auscultation, the authors conclude that the critical auscultation as commonly performed is not capable of excluding the presence of a carotid lesion with sufficient reliability, even in totally asymptomatic patients.

Predictive value of asymptomatic cervical bruit for carotid artery disease in coronary artery surgery revisited

“…However, other investigators documented a fairly low specificity (40 -44%) for a mixed patient population with or without cerebrovascular symptoms [19,22,25,28]. In our sample of asymptomatic patients undergoing CABG the specificity of cervical bruit was 98.6% for all grades of internal carotid artery disease and 93.5% for occlusive disease with haemodynamic impairment.…”

Carotid bruits as predictor for carotid stenoses detected by ultrasonography: an observational study

“…In the study of Ghilardi, carotid kinking and occlusion were regarded as a carotid lesion[ 9 ]. Floriani et al found a sensitivity and specificity of carotid bruits to predict a carotid lesion of 84% and 40%, respectively[ 10 ], rendering a positive likelihood percentage (PLP) value of 29% and a negative likelihood percentage (NLP) value of 60%. Sauve et al found a sensitivity, specificity, positive and negative likelihood percentages of 63%, 61%, 38% and 39%, respectively, for 70–99% stenoses when studying the NASCET-population[ 11 ].…”