Elliot Kim
Vascular sounds are common in children, and they can be innocent or pathologic. Innocent vascular sounds are nonorganic and indicate no regional anatomic disease. They are common in the cervical region and are related to high carotid flow in children with high cardiac output. Innocent supraclavicular systolic bruits are also common in children and adolescents and are usually abrupt systolic sounds of brief duration. On the other hand, pathologic vascular sounds are organic and indicate localized vascular obstruction. Cranial and orbital bruits are usually normal in younger persons, occurring in 30 to 60% of normal infants and children under 6 years of age.
| Characteristics | Values |
|---|---|
| Vascular sounds common in children | Cervical venous hum, systolic regurgitant murmur, early diastolic murmurs, late diastolic murmurs, innocent heart murmurs, cranial and orbital bruits, innocent supraclavicular systolic bruits, abdominal aortic bruits |
| Innocent heart murmurs | Sounds from thin heart walls vibrating with rushing blood, disappear as a child gets older |
| Innocent supraclavicular systolic bruits | Abrupt systolic sounds of brief duration, may be loud and radiate widely, decrease or vanish when shoulders are hyperextended |
| Cervical venous hum | Common in children, less frequent in adults |
| Cranial and orbital bruits | Occur in 30-60% of normal infants and children under 6 years of age |
| Systolic regurgitant murmur | Heard throughout systole beginning with S1 at the pulmonary area |
| Early diastolic murmurs | Occur immediately after S2, caused by inept aortic and pulmonic valves |
| Mid-diastolic murmurs | Caused by mitral and tricuspid stenosis, rare in children |
| Late diastolic murmurs | Caused by abnormal mitral or tricuspid valve, uncommon in children |
| Auscultation | Use of a stethoscope to listen to vascular sounds |
| Stethoscope | Bell for low frequencies, diaphragm for high frequencies |
| Vascular murmurs | 44% of people under 25 have vascular murmurs |
| Lung sounds | Coarse crackles, stridor, sonorous wheezes, sibilant wheezes |
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What You'll Learn
Innocent heart murmurs
Identifying innocent heart murmurs is crucial to avoid misdiagnosis and unnecessary treatment. A thorough medical history, physical examination, and focused history, including perinatal, prenatal, and maternal history, are essential tools for evaluation and identification. Auscultation is a technique used to listen to heart sounds and is more effective for learning than recordings.
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Vascular rings
Vascular sounds are common in children. Innocent supraclavicular systolic bruits, for instance, are often heard in normal children or adolescents. These innocent murmurs tend to decrease or vanish when the shoulders are hyperextended. The most common continuous murmur, the cervical venous hum, occurs most commonly in children between the ages of 3 and 6. It is only heard when a child sits, and it disappears when the child turns their head.
A vascular ring is a congenital birth defect involving the aorta, the main artery that carries blood away from the heart to the body. The aorta starts normally at the heart as one large vessel but then divides into two arches, one on each side of the trachea and oesophagus. The two arches then come back together into one vessel (the descending aorta). The aorta starts off to the right, instead of the left (as is normal), and gives off an abnormal branch from the descending aorta. This abnormal branch passes behind the oesophagus and gives off the vessel to the left arm (the left subclavian artery) and the ligamentum arteriosum. The ligamentum arteriosum is a remnant of a blood vessel that exists normally in the fetus; it runs between the aorta and the pulmonary artery, completing the ring and possibly constricting the trachea and/or oesophagus. The structure of the vascular ring and its relationship to the trachea and oesophagus varies from child to child.
The symptoms of a vascular ring include noisy or laboured breathing, especially with eating; difficulty eating and swallowing; and dysphagia, the feeling of something being stuck in the throat. In most cases, the symptoms of a vascular ring are mild, and the condition may go undiagnosed until the child is older, or even an adult. If the condition is severe and the child is experiencing breathing difficulties, a vascular ring may be diagnosed within the first few weeks or months of life. Diagnosis of a vascular ring may require a bronchoscopy, where a doctor examines the trachea using an instrument called a bronchoscope while the patient is under anaesthesia.
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Cervical venous hum
Vascular sounds are common in children, especially in the cervical region. Innocent vascular sounds must be differentiated from organic (pathologic) bruits. Cervical venous hum is a common vascular sound in children and is considered a benign phenomenon caused by the normal flow of blood through the jugular veins. It is often heard in children between the ages of 3 and 6 and can be heard when a child is sitting. The sound disappears when the child turns their head.
The venous hum is a result of the rush of blood from the internal jugular veins to the brachiocephalic vein, causing the vein walls to vibrate and create a humming noise. This humming sound is typically heard near the clavicle, just lateral to the sternocleidomastoid muscle and may radiate to the upper sternal border. While the venous hum is typically louder during diastole, it can be enhanced by certain factors such as sitting upright, elevating the chin, or rotating the head.
Although the venous hum is typically harmless, it can sometimes be confused with a heart murmur, which may indicate a more serious condition. To differentiate between the two, light pressure can be applied to the internal jugular vein while listening to the heart sounds. A venous hum will be altered or abolished, whereas a true heart murmur will remain unchanged.
In rare cases, a cervical venous hum in adults or adolescents may indicate intracranial arteriovenous malformations, especially if accompanied by symptoms such as subarachnoid hemorrhage, migraine-like headaches, or epilepsy. However, this is not a common occurrence and requires further evaluation by a healthcare professional.
Overall, the cervical venous hum is a common vascular sound in children and is typically a benign finding. It is important for healthcare professionals to be able to distinguish between innocent vascular sounds and pathologic bruits to provide accurate diagnoses and alleviate any concerns.
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Cranial and orbital bruits
Vascular sounds are common in children, and these are usually nonorganic (innocent) and point to no regional anatomic disease. Cranial and orbital bruits are vibrations resulting from turbulence in intracranial or extracranial vessels. They are usually systolic in timing but may extend into diastole or even be continuous. These sounds may originate within the cranium or be transmitted from arteries in the neck or, occasionally, from cardiac valvular lesions. The orbits provide a relatively clear transmission of intracranial sounds, with minimal bony dissipation.
Cranial bruits should be listened for over the skull and eyeballs, with the latter being the most favorable location for fainter sounds. The patient is asked to close both eyes gently, and the examiner places the stethoscope bell firmly over one closed eye. The examiner's other hand rests lightly on the contralateral carotid artery for timing and to steady the head and neck. Orbital bruits may be faint and high-pitched, and the examiner should concentrate on the systolic phase of the cardiovascular cycle.
In adults, if the above conditions are excluded, cranial-orbital bruits usually indicate an underlying abnormality. Arteriovenous fistulas, arteriovenous malformations, and intracranial hemangiomas are associated with prominent bruits in 30 to 50% of cases. Orbital bruits can also be found in systemic illnesses such as severe anemia and vascular anomalies such as carotid-cavernous fistulas.
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Ultrasound diagnosis
Vascular sounds are common in children, and healthcare providers use vascular ultrasound to determine how blood flows in arteries and veins in the arms, neck, and legs. Ultrasound diagnosis is a non-invasive, painless, and safe procedure that uses high-frequency sound waves to create detailed images. These sound waves pass through soft tissues and blood vessels, and the echoes created are converted into images or videos by a computer.
Before the ultrasound, a lubricating gel is applied to the skin in the areas to be examined, usually the neck, arms, and legs. A special probe called a transducer is then pressed against the skin and moved over the area. The procedure is painless, and the patient may only feel a little pressure from the probe.
Vascular ultrasound helps diagnose blood clots, narrowed blood vessels, and other vascular health conditions. It can also be used to check blood flow to organs and tissues throughout the body, which is particularly useful for patients who have received organ transplants. Additionally, vascular ultrasound can be used to determine if a patient is a good candidate for angioplasty or to check blood vessel health after venous disease bypass surgery.
Doppler ultrasound is a special type of ultrasound that is often used as part of a vascular ultrasound examination. It evaluates the movement of materials in the body, specifically the direction of blood flow through arteries and veins. Color Doppler, an enhanced form of Doppler ultrasound, uses different colors to indicate the direction of blood flow.
Vascular ultrasound is a valuable tool for diagnosing and monitoring vascular health conditions in children and adults. It provides detailed images of blood vessels and blood flow, aiding healthcare providers in making accurate diagnoses and determining appropriate treatments.
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Frequently asked questions
Vascular sounds are common in children. Innocent supraclavicular systolic bruits are often heard in normal children or adolescents. Innocent vascular sounds are common in the cervical region and are usually abrupt systolic sounds of brief duration.
Innocent vascular sounds are non-organic and point to no regional anatomic disease. They are also known as innocent heart murmurs, which are sounds that come from thin heart walls that vibrate with rushing blood and disappear as a child gets older.
The cervical venous hum is the most common continuous murmur and occurs most commonly in children between the ages of 3 and 6. You can only hear it when a child sits, and it disappears when the child turns their head. Another example is Still’s murmur, which is common among young children and is heard best at the left lower sternal border of the heart.
Abnormal vascular sounds are organic (pathologic) and indicate a localized vascular obstruction and the need for further evaluation. For example, abnormal vascular sounds in the neck, such as bruits, could indicate carotid artery pathology.
Symptoms of abnormal vascular sounds in children can include noisy or labored breathing, especially during eating, difficulty swallowing, and a feeling of something being "stuck in the throat". In severe cases, a child may have trouble breathing, and surgery may be required.
