Differential Diagnosis for Abdominal Palpitation like Heart Beat in Diaphragm Area

Single Most Likely Diagnosis

• Aortic Aneurysm or Aortic Pulsation: This is the most likely diagnosis because an abdominal aortic aneurysm can cause a palpable pulsation in the abdominal region, which might be felt in the diaphragm area due to its proximity to the aorta. The pulsation is due to the heartbeat causing the aneurysm to expand and contract.

Other Likely Diagnoses

• Abdominal Aortic Atherosclerosis: Similar to an aortic aneurysm, significant atherosclerosis of the abdominal aorta can lead to a palpable abdominal pulse, especially if there is a significant stenosis or if the aorta is ectatic.
• Hepatomegaly with Arteriovenous Fistula: In cases of liver disease or after certain procedures, arteriovenous fistulas can form, leading to increased blood flow through the liver, which might be palpable as a pulsation.
• Splenic Artery Aneurysm: Although less common, an aneurysm of the splenic artery can cause a palpable pulsation in the left upper quadrant, which might be referred to the diaphragm area.

Do Not Miss Diagnoses

• Ruptured Abdominal Aortic Aneurysm: This is a medical emergency. A ruptured aneurysm can present with a palpable abdominal mass and pulsation, along with severe abdominal or back pain and potentially hypotension.
• Ectopic Pregnancy: In early pregnancy, an ectopic pregnancy can cause abdominal pain and a palpable mass if it has ruptured, though the pulsation would be less typical. However, given the potential for severe consequences, it's crucial not to miss this diagnosis in women of childbearing age.
• Intra-Abdominal Hemorrhage: Internal bleeding within the abdominal cavity can lead to a palpable mass and potentially a sensation of pulsation due to the movement of blood, especially if it's near major vessels.

Rare Diagnoses

• Arteriovenous Malformation (AVM): AVMs within abdominal organs can cause increased blood flow, potentially leading to palpable pulsations, though they are relatively rare.
• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension and potentially palpable abdominal masses or pulsations due to its vascular nature.
• Inferior Vena Cava Obstruction or Thrombosis: Obstruction or thrombosis of the inferior vena cava can lead to increased venous pressure and potentially palpable pulsations in the abdomen, though this would be more of a venous pulsation rather than arterial.