Abdominal bruit

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

An abdominal bruit is a murmur heard when the diaphragm of stethoscope is placed over the spleen, renal arteries, or abdominal aorta. It is often indicative of partial occlusion of a vessel, as can be observed in renal artery stenosis or atherosclerosis of the abdominal vasculature.

Causes

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
• Fibromuscular dysplasia
• Hepatocellular carcinoma (hepatic)
• Hepatoma
• Inflammatory processes
• Liver hemangioma
• Liver metastases
• Renal artery stenosis
• Superior mesenteric artery stenosis
• Takayasu's Arteritis
• Tricuspid regurgitation
• Tumor that is highly vascularized
• Turbulence of the splenic artery
• Vasculitis

Complete Differential Diagnosis of the Causes of Abdominal Bruit

(By organ system)

Cardiovascular	Abdominal aortic aneurysm, Aortic aneurysm, Arteriovenous malformation, Celiac artery stenosis, Tricuspid regurgitation, Turbulence of the splenic artery, Cruveilhier-Baumgarten murmur
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Cirrhosis, Cholangiocarcinoma, Hepatic venous hum, Hepatocellular carcinoma (hepatoma), Hepatoma, Liver hemangioma, Liver metastases, Superior mesenteric artery stenosis, Turbulence of the splenic artery
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Cholangiocarcinoma, Hepatocellular carcinoma (hepatoma), Hepatoma, Liver metastases
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	Renal artery stenosis
Rheum / Immune / Allergy	Inflammatory processes, Takayasu's Arteritis, Vasculitis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Abdominal friction rub

Diagnosis

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:

  • 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

Other Imaging Findings

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