Abdominal bruit
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Abdominal bruit Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Abdominal bruit On the Web |
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American Roentgen Ray Society Images of Abdominal bruit |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
An abdominal bruit is a swishing, or washing machine like sound 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
Causes 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 |
Causes 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
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:
- 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 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.
- Treat underlying etiology
- Consult nephrology for appropriate management of renal insufficiency
- Consult vascular surgery for symptomatic and/or severly stenotic vessels
References