Landlfi徴候
https://www.nejm.org/doi/full/10.1056/NEJMicm1901850
The ophthalmologic examination revealed dilation and constriction of the pupils, synchronized with the patient’s heartbeat.
Known as Landolfi’s sign, this finding may be seen in patients with severe aortic regurgitation and is a manifestation of wide pulse pressure and large stroke volume in the iridial vessels, which causes systolic constriction and diastolic dilation of the pupils.
Transthoracic echocardiography revealed severe aortic regurgitation with dilatation of the ascending aorta and a dissection flap.
Computed tomographic scans of the aorta showed a Stanford type A aortic dissection. The patient underwent replacement of his ascending aorta and aortic valve (Bentall procedure).
On discharge 10 days later, Landolfi’s sign was no longer present.
aortic [valve] regurgitation (AR) 大動脈弁逆流[症]の身体所見歴史伝説特集
これに様々なeponymous的身体所見31種類が記載されている
Austin Flint Murmurのような聴診所見も含まれるが・・・
↓
Aortic Regurgitation Eponymythology
by Dr Gary Zhang and Dr Mike Cadogan, last update September 6, 2019
https://litfl.com/aortic-regurgitation-eponymythology/
上記Landlfi徴候は1909年
この瞳孔の拡大・縮小はわかりやすい
https://www.youtube.com/watch?v=Ccva6828w1s
感度や特異度解説に書いてないんだよなぁ・・・NEJM
さらに、1981年の報告
Quincke, de Musset, Duroziez, and Hill: some aortic regurgitations.
South Med J. 1981 Apr;74(4):459-67.
https://www.ncbi.nlm.nih.gov/pubmed/7013091
(1) Quincke's capillary pulse sign is not useful.
(2) de Musset's head bobbing sign is of undetermined but apparently low sensitivity and specificity.
(3) Duroziez's femoral double intermittent murmur sign, as modified by Blumgart and Ernstene, is almost 100% specific for the diagnosis of aortic insufficiency. Since its sensitivity, when properly performed, is about 90%, especially in pure aortic insufficiency, it is highly recommended.
(4) Hill's sign (a popliteal indirect systolic blood pressure which is 20 mm Hg greater than a simultaneously measured brachial indirect systolic blood pressure) though almost unknown, is useful in diagnosing all but the mild cases of aortic insufficiency, and is the only sign that may predict the degree of aortic insufficiency subsequently found angiographically.
Hill徴候のみ含みあり
発展型がこれ？
↓
cardio-ankle vascular index (CAVI)
Usefulness of peripheral arterial signs in the evaluation of aortic regurgitation.
J Cardiol. 2017 May;69(5):769-773. doi: 10.1016/j.jjcc.2016.07.005. Epub 2016 Aug 5.
https://linkinghub.elsevier.com/retrieve/pii/S0914-5087(16)30152-6
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