From the Guidelines
A left-sided abdominal bruit is most likely caused by renal artery stenosis, which is suggested by the presence of abdominal bruits, as indicated in the American Heart Association's scientific statement on resistant hypertension 1. The presence of a left-sided abdominal bruit typically indicates turbulent blood flow through a narrowed or abnormal blood vessel in the left side of the abdomen. Key causes to consider include:
- Renal artery stenosis affecting the left kidney, where atherosclerotic plaque or fibromuscular dysplasia narrows the left renal artery
- Abdominal aortic aneurysm
- Mesenteric artery stenosis, particularly the superior mesenteric artery
- Splenic artery stenosis or aneurysm
- Arteriovenous malformations or fistulas in the left abdomen The bruit occurs because blood flow becomes turbulent when passing through a narrowed vessel segment. When detected during physical examination, a left-sided abdominal bruit warrants further investigation with imaging studies such as duplex ultrasound, CT angiography, or MR angiography to identify the underlying vascular abnormality, as it may indicate significant vascular disease requiring medical management or intervention, as suggested by the evaluation of resistant hypertension 1.
From the Research
Causes of Left-Sided Abdominal Bruit
- Atherosclerotic renal artery stenosis (RAS) is a common cause of secondary hypertension and can lead to an abdominal bruit 2, 3, 4
- Fibromuscular dysplasia is another cause of renal artery stenosis, which can also result in an abdominal bruit 3, 5
- Celiac trunk stenosis and/or aneurysms located on the pancreaticoduodenal or gastroduodenal arcs level can also cause an abdominal bruit 6
- Other vascular diseases of the abdomen, such as aneurysms, can also lead to an abdominal bruit 6
Diagnosis of Abdominal Bruit
- Physical examination and the presence of a typical abdominal bruit can provide helpful hints to identify hypertensive patients with possible renal artery stenosis 3
- Doppler ultrasound, computed tomography angiography, magnetic resonance angiography, or selective angiogram can be used to diagnose renal artery stenosis 4, 5
- Abdominal arteriography is the best method for diagnosing and treating aneurysms located on the pancreaticoduodenal or gastroduodenal arcs level 6
Clinical Significance of Abdominal Bruit
- Abdominal bruit is associated with renovascular hypertension, which can lead to renal insufficiency, uncontrolled hypertension, and increased cardiovascular morbidity 3, 4
- Early diagnosis of renal artery stenosis is important to improve or cure hypertension and preserve renal function 5
- A quick diagnosis is necessary to prevent the risk of rupture and high morbi-mortality associated with aneurysms 6