Spectral Doppler tracing of locomotor brachii sign in severe aortic insufficiency.

Abstract

A 37-year-old gentleman with no significant past medical history presented to the emergency department with a two-week history of progressively worsening shortness of breath. Vital signs were stable on arrival and initial physical exam was remarkable for a high pitched early diastolic decrescendo murmur at the left lower sternal border. Further physical examination revealed bounding carotid pulses (consistent with Corrigan's sign), and a systolic contraction and diastolic dilation of pupil (consistent with Landolfi's sign). Brachial artery was noted to be tortuous and prominently pulsatile with a bruit audible on auscultation, consistent with locomotor brachii (panel A). Upon further evaluation using point of care ultrasound, diastolic flow reversal and double bruit (both systolic and diastolic) on compression, were noted on spectral Doppler tracing (panel B). Transthoracic echocardiography showed bicuspid aortic valve with flail leaflet and severe eccentric aortic insufficiency; thereby confirming the diagnosis of aortic regurgitation. The patient eventually underwent a surgical aortic valve replacement with mechanical valve.