Abnormal Abdominal Murmurs

1. What is the pitch and timing of the stenosing renal vascular lesion murmur?

ANS: It is high-pitched, sometimes to and fro with systolic accentuation, sometimes only a short systolic murmur, and sometimes continuous.

Note: a. The kind of renal artery lesion that is most likely to have an arterial murmur is fibromuscular dysplasia. b. A continuous murmur means either an arteriovenous fistula of the portal system or renal artery stenosis.

c. If a venous hum is present over the xiphoid region or umbilicus and is heard over the chest, suspect hepatic cirrhosis with portal systemic anastomoses (Cruveilhier-Baumgarten syndrome). Systolic accentuation occurs with inspiration or sitting up. Firm pressure at the site of a thrill may cause the murmur to disappear.

2. Where are the best sites for hearing renal vascular murmurs?

ANS: Beneath the costal margin anteriorly, lateral to the aorta and lumbar spine. Renal artery stenosis murmurs are usually 2-4 in. lateral to the midepigastrium. Occasionally they are heard in the flanks over the kidneys.

Note: An epigastric murmur is more likely to be due to celiac artery compression than to renal artery stenosis. Pulsations of the normal abdominal aorta do not extend below the umbilicus, and such a pulsation even in thin individuals suggests an aneurysm.

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