Duroziez’s sign is a double murmur (systolic and diastolic) heard over a large peripheral artery, most commonly the femoral artery, when it is alternately compressed proximally and distally with a stethoscope.

• Systolic murmur → heard with proximal compression.

• Diastolic murmur → heard with distal compression.

It is a clinical indicator of aortic insufficiency (aortic regurgitation).

Pathophysiology

• In aortic insufficiency, the regurgitant blood flow back into the left ventricle causes:

  • High stroke volume → strong systolic flow across peripheral arteries.

  • Rapid diastolic runoff → turbulence in diastole.

• Compression of the femoral artery modifies the flow, producing audible murmurs that correlate with systolic ejection and diastolic backflow.

• Reflects the hyperdynamic circulation typical of severe aortic regurgitation.

Examination Technique

Patient Positioning

• Patient lies supine with legs relaxed.

Steps

1. Place the stethoscope bell or diaphragm over the femoral artery in the groin.

2. Apply proximal compression (toward the heart): listen for a systolic murmur.

3. Apply distal compression (away from the heart): listen for a diastolic murmur.

Positive Test

• Presence of both murmurs = positive Duroziez’s sign, highly suggestive of aortic insufficiency.

Clinical Features & Utility

• Strongly associated with aortic regurgitation.

• Often seen alongside other peripheral signs of AR:

  • Corrigan’s pulse (water-hammer pulse).

  • de Musset’s sign (head nodding with heartbeat).

  • Müller’s sign (uvular pulsation).

  • Quincke’s sign (capillary pulsations).

• Provides a bedside clue in resource-limited settings when echocardiography is not available.

Differential Diagnosis (Other Causes of Murmurs over Femoral Artery)

Limitations

• Requires skillful auscultation and proper technique.

• Not specific; may be confused with other vascular bruits.

• Best interpreted in the context of other AR signs and echocardiography.

Patient counseling

• Explain that the sound over the artery reflects abnormal backward blood flow through the aortic valve.

• Emphasize the need for echocardiography to confirm severity.

• Reassure that early diagnosis allows for medical therapy and timely surgical consideration.

Conclusion

Duroziez’s sign is a classic peripheral auscultatory finding of aortic regurgitation, characterized by a double murmur over the femoral artery with alternating compression. Though not pathognomonic, it strongly suggests severe AR and should prompt further cardiac evaluation.

References

1. Duroziez P. Nouvelles recherches sur l’insuffisance des valvules aortiques. Arch Gen Med. 1861;18:385–403.

2. Bickley LS, Szilagyi PG, Hoffman RM. Bates’ Guide to Physical Examination and History Taking. 13th ed. Wolters Kluwer; 2021.

3. Otto CM, Nishimura RA, Bonow RO. Valvular Heart Disease: A Companion to Braunwald’s Heart Disease. 5th ed. Elsevier; 2020.

4. Carabello BA. Modern management of aortic regurgitation. Circulation. 2005;112(3):432–437.