Abdominal Bruit
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
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Abdominal aortic aneurysm
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Hepatocellular carcinoma (hepatoma)
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Cirrhosis
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Liver hemangioma
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Arteriovenous malformation
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Renal artery stenosis
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Celiac artery stenosis
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Superior mesenteric artery stenosis
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Tricuspid regurgitation
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Turbulence of the splenic artery
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Hepatic venous hum
–High-pitched continuous murmur that decreases with forced held expiration
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Cruveilhier-Baumgarten murmur
–High-pitched venous hum of portal hypertension that becomes louder with forced expiration
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Abdominal friction rub
–Associated with hepatoma, cholangiocarcinoma, liver metastases, inflammatory processes
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Takayasu's arteritis
Workup and Diagnosis
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History and physical exam with focus on abdominal exam (may have palpable thrill), cardiac exam, four extremity pulses, and blood pressure
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Ultrasound is often the initial test and is diagnostic for AAA, liver metastases, and liver and spleen sizes
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Abdominal CT will demonstrate abdominal pathology and is useful to better delineate anatomy
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Arterial Doppler ultrasound
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Angiography is diagnostic for stenosis
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Measuring renal vein renin levels following a captopril challenge is diagnostic for renal artery stenosis
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Radionuclide nephrograms or IV urography will demonstrate differences in perfusion of kidneys with stenotic artery
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Echocardiogram may be indicated to evaluate for valvular dysfunction
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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
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Initial treatment is to stabilize and resuscitate the patient as needed
–Attention to airway, breathing, and circulation
–Immediate repair of ruptured abdominal aneurysm
Treat the underlying etiology
Vascular surgical consultation may be necessary for severely stenotic and/or symptomatic vessels
Nephrology consult may be needed for renal insufficiency or to help with appropriate medication choices
Treat hypertension if present
–Always avoid ACE inhibitors in patients with bilateral renal artery stenosis
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 Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Vein symptoms
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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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