Abdominal bruit

Overview

 * Murmur corresponding to cardiac cycle
 * Best heard with diaphragm of stethoscope over the spleen, renal arteries, or abdominal aorta
 * Can be indicative of:
 * Fibromuscular hyperplasia
 * Artherosclerosis
 * Can be heard as a result external compression (because of extreme pressure by stethoscope or a mass)
 * Can be heard over large, highly vascular tumor
 * Can be heard as a result of partial occlusion of a vessel

Common Causes

 * Cirrhosis


 * Renal artery stenosis

Complete Differential Diagnosis of the Causes of Abdominal Bruit
(In alphabetical order)


 * Abdominal aortic aneurysm
 * Abdominal friction rub
 * Aortic aneurysm
 * Arteriovenous malformation
 * Celiac artery stenosis
 * Cholangiocarcinoma
 * Cirrhosis
 * Cruveilhier-Baumgarten murmur
 * Hepatocellular carcinoma (hepatic)
 * Hepatoma
 * Inflammatory processes
 * Liver hemangioma
 * Liver metastases
 * Renal artery stenosis
 * Superior mesenteric artery stenosis
 * Takayasu's Arteritis
 * Tricuspid regurgitation
 * Turbulence of the splenic artery
 * Vasculitis

Complete Differential Diagnosis of the Causes of Abdominal Bruit
(By organ system)

Abdomen

 * May have palpable thrill in addition to the murmur.

Laboratory Findings

 * Captopril challenge followed by measuring renal vein renin levels diagnoses renal artery stenosis.
 * Lipid panel for arteriosclerosis
 * Suspected inflammatory processes:
 * Erythrocyte sedimentation rate (ESR)
 * Complete blood count
 * Liver function tests (LFTs) to evaluate liver

MRI and CT

 * CT of abdomen may be helpful in evaluating underlying pathology.

Echocardiography or Ultrasound

 * Ultrasound used as initial test
 * Arterial Doppler ultrasound helps diagnose
 * Echocardiogram evaluates valvular dysfunction

Angiography

 * Can be used to diagnoses stenoses including renal artery stenosis

Other Diagnostic Studies

 * IV urography or radionuclide nephrograms will show differences in kidney perfusion with stenotic artery

Treatment

 * In the critically ill patient with a ruptured aortic aneurysm, the first goal is to stabilize the patient and repair the aneurysm immediately.
 * In the patient with renal artery stenosis, the goal is to treat the hypertension
 * In patients with bilateral stenosis, avoid ACE inhibitors (always).
 * Treat underlying etiology
 * Consult nephrology for appropriate management of renal insufficiency
 * Consult vascular surgery for symptomatic and/or severly stenotic vessels

Acknowledgements
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