Abdominal bruit
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-525-6884
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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
Differential Diagnosis
- Cirrhosis
- Takayasu's Arteritis
- Hepatic venous hum
- High-pitched continuous murmur that with forced held expiration, decreases
- Celiac artery stenosis
- Liver hemangioma
- Hepatocellular carcinoma (hepatoma)
- Renal artery stenosis
- Abdominal friction rub
- Associated with inflammatory processes, hepatoma, liver metastases, cholangiocarcinoma
- Abdominal aortic aneurysm
- Arteriovenous malformation
- Cruveilhier-Baumgarten murmur
- High-pitched continuous murmur that with forced held expiration, becomes louder
- Superior mesenteric artery stenosis
- Turbulence of the splenic artery
- Tricuspid regurgitation
Physical Examination
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:
- Liver function tests (LFTs) to evaluate liver
MRI and CT
Echocardiography or Ultrasound
- Ultrasound used as initial test
- Arterial Doppler ultrasound helps diagnose
- Echocardiogram evaluates valvular dysfunction
Other Imaging Findings
Angiography
- Can be used to diagnoses stenoses including renal artery stenoses
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
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
Acknowledgements
The content on this page was first contributed by Heather Mangan, Caitlin Harrigan and Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3] Phone:617-525-6884
List of contributors:
Suggested Reading and Key General References
Suggested Links and Web Resources
For Patients
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
