Abdominal Bruit

Abdominal Bruit: Excerpt from In a Page: Signs and Symptoms

An abdominal bruit is a murmur that corresponds to the cardiac cycle. It is heard best with the diaphragm of the stethoscope, usually over the abdominal aorta, renal arteries, or spleen. It can be a sign of atherosclerosis or fibromuscular hyperplasia. However, it may also be heard over a large, highly vascular tumor, or as a result of partial occlusion of a vessel, secondary to external compression (e.g., due to extreme pressure by stethoscope or a mass).

Differential Diagnosis

• Abdominal aortic aneurysm
• Hepatocellular carcinoma (hepatoma)
• Cirrhosis
• Liver hemangioma
• Arteriovenous malformation
• Renal artery stenosis
• Celiac artery stenosis
• Superior mesenteric artery stenosis
• Tricuspid regurgitation
• Turbulence of the splenic artery
• Hepatic venous hum
  –High-pitched continuous murmur that decreases with forced held expiration
• Cruveilhier-Baumgarten murmur
  –High-pitched venous hum of portal hypertension that becomes louder with forced expiration
• Abdominal friction rub
  –Associated with hepatoma, cholangiocarcinoma, liver metastases, inflammatory processes
• Takayasu's arteritis

Workup and Diagnosis

• History and physical exam with focus on abdominal exam (may have palpable thrill), cardiac exam, four extremity pulses, and blood pressure
• Ultrasound is often the initial test and is diagnostic for AAA, liver metastases, and liver and spleen sizes
• Abdominal CT will demonstrate abdominal pathology and is useful to better delineate anatomy
• Arterial Doppler ultrasound
• Angiography is diagnostic for stenosis
• Measuring renal vein renin levels following a captopril challenge is diagnostic for renal artery stenosis
• Radionuclide nephrograms or IV urography will demonstrate differences in perfusion of kidneys with stenotic artery
• Echocardiogram may be indicated to evaluate for valvular dysfunction
• Laboratory studies may include a lipid panel to evaluate for arteriosclerosis; CBC and ESR if inflammatory processes are suspected; liver function tests to evaluate for liver dysfunction; and electrolytes and renal function tests if renal artery stenosis is suspected

Treatment

• Initial treatment is to stabilize and resuscitate the patient as needed
  –Attention to airway, breathing, and circulation
  –Immediate repair of ruptured abdominal aneurysm

Book Source Details

• Book Title: In a Page: Signs and Symptoms
• Author(s): Scott Kahan, Ellen G. Smith
• Year of Publication: 2004
• Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In a Page: Signs and Symptoms Authors: Scott Kahan, Ellen G. Smith Publisher: Lippincott Williams & Wilkins Copyright: 2004 ISBN: 1-4051-0368-X

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