Rule Out Abdominal Bruits

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The patient should be supine. The examiner places the diaphragm of the stethoscope in the midline of the patient's abdomen about 2 inches (5 cm) above the umbilicus and listens carefully for the presence of an aortic bruit. This technique is demonstrated in Figure 15-8.

A renal bruit may be the only clue to renal artery stenosis. Auscultation should be performed about 2 inches (5 cm) above the umbilicus and 1 to 2 (2.5 to 5 cm) inches laterally to the right and to the left of midposition.

Figure 15-8 Technique for auscultation of the abdominal aorta.

Figure 15-8 Technique for auscultation of the abdominal aorta.

Auscultation Abdomen Fig

Abdominal bruits that are present only during systole are frequently of little clinical value because they are found in normal individuals and in patients with essential hypertension. The presence of a systolic-diastolic abdominal bruit, however, should raise the suspicion of renovascular hypertension. Nearly 60% of all patients with renovascular hypertension have such a bruit.

The presence of a combined systolic-diastolic abdominal bruit has a sensitivity of 39% and a specificity of 99% for detecting renovascular hypertension. The presence of this type of bruit has a positive likelihood ratio (LR+) of 39 and, if absent, a negative likelihood ratio (LR—) of 0.6. In a study that evaluated the presence of any epigastric or flank bruit and its association with renovascular hypertension, the sensitivity was 63%, but the specificity dropped to 90%. The presence of any abdominal bruit confers a much lower LR+ for renovascular hypertension (i.e., 6.4).

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