title: Clinical relevance of musical murmurs in color-coded duplex sonography of peripheral and visceral vessels.
abstract: BACKGROUND
  Musical murmurs (MMs) are Doppler phenomena which sound like high-frequency musical sounds. They reflect high and turbulent flow within relevant stenoses and were first described in degenerated bioprosthetic valves and later in intracranial vessels and were associated either with high-grade arterial stenosis, small collateral arteries or carotid cavernous fistulas. Objective of this article is to illustrate the spectrum of imaging of MMs observed in renal, intestinal and peripheral vessels.
  
  
  METHODS
  Four experienced vascular ultrasound laboratories had been asked to report their cases with documented musical tones in color coded duplex sonography (CCDS) within a two year observational period (2008 and 2009). Documented Doppler findings and corresponding clinical data were analyzed.
  
  
  RESULTS
  MMs were found in 18 patients with an incidence of 0.05 % and were observed in high grade stenosis in hemodialysis access (n = 5), in post-biopsy arteriovenous fistulas after renal transplantation (n = 3), in renal transplant artery (n = 1) and vein (n = 3), stenoses in peripheral (n = 2) and intestinal arterial disease (n = 2), and in peripheral veins (n = 2).
  
  
  CONCLUSIONS
  The so called musical murmurs are a rare but potentially relevant finding in CCDS. They are caused by a variety of underlying pathologies with different clinical implications, however correct interpretation is mandatory since urgent therapy might be necessary.
authors.affiliation: University Hospital Zurich, Switzerland. christoph.thalhammer@usz.ch
authors.forename: C
authors.initials: C
authors.lastname: Thalhammer
authors.forename: M
authors.initials: M
authors.lastname: Aschwanden
authors.forename: M
authors.initials: M
authors.lastname: Husmann
authors.forename: C
authors.initials: C
authors.lastname: Jeanneret
authors.forename: V
authors.initials: V
authors.lastname: Jacomella
authors.forename: R K J
authors.initials: RK
authors.lastname: Clemens
authors.forename: K
authors.initials: K
authors.lastname: Stock
authors.forename: B R
authors.initials: BR
authors.lastname: Amann-Vesti
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000000981:diagnostic imaging; D001164:Arteriovenous Fistula / Q000000981:diagnostic imaging; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D003251:Constriction, Pathologic; D005260:Female; D005858:Germany; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006785:Hospitals, University; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009146:Music; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012078:Renal Artery Obstruction / Q000000981:diagnostic imaging; D006435:Renal Dialysis; D013557:Switzerland; D018615:Ultrasonography, Doppler, Color; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D014680:Veins / Q000000981:diagnostic imaging; D014732:Vibration; D014781:Viscera / Q000098:blood supply*