The mammary souffle of pregnancy and lactation.

IN 1908 van den Bergh' described a loud systolic murmur of unusual quality that appeared in a woman the day after parturition. It was localized to a small area in the second right intercostal space, and disappeared entirely when firm pressure with the stethoscope bell was applied over the site of maximum intensity. He believed the murmur was extracardiae, and owed its origin to enlarged tortuous branches of the internal mammary artery. In an extensive study of women during pregnancy and the puerperium he found 13 instances of such a murmur. Fresh interest in the origin and mechanism of this extracardiac murmur has recently developed.2-9 Scott and Murphy7 introduced the term mammary souffle to describe the murmur, since they considered the mechanism similar to that of the uterine souffle. We have recently encountered several examples of a mammary souffle in patients referred with such diagnoses as patent ductus arteriosus, aortic stenosis with regurgitation, and ventricular septal defect. The diagnostic difficulties created by these cases stimulated the following investigation into the incidence and clinical features of the mammary souffle.