Which of the following is most clearly an indication for carotid duplex ultrasound?

• A. Headache
• B. Normal neurological examination
• C. Pulmonary hypertension
• D. Cervical bruit

Answer: (D)

A cervical bruit on physical exam is the clearest sign that carotid artery disease might be present and warrants carotid duplex ultrasound. A bruit implies turbulent blood flow from a narrowed carotid artery, and duplex ultrasound is the noninvasive test that both visualizes the artery and measures blood flow velocities to estimate the degree of stenosis. This helps stratify stroke risk and guide management.

Headache is a nonspecific symptom and does not by itself indicate carotid stenosis, especially with a normal neurological exam. Pulmonary hypertension relates to the heart and lungs, not the carotid arteries, so it doesn’t prompt carotid imaging. A normal neurological examination lowers the likelihood of acute carotid-related stroke but does not specifically indicate imaging for carotids. Thus, the presence of a cervical bruit best signals the need for carotid duplex ultrasound.