A patient with cirrhosis, a side-to-side portacaval shunt, and a loud abdominal murmur was observed. Investigation revealed enlarged, tortuous, hepatic arteries as the most likely source for this murmur—a hepatic arterial bruit. The generation of this bruit was considered to be secondary to the disturbance in normal laminar blood flow in the enlarged, tortuous, hepatic arteries. This case is reported to add hepatic-artery variations to the list of causes of abdominal arterial murmurs in patients with liver disease.
Goldstein LI. Enlarged, Tortuous Arteries and Hepatic Bruit. JAMA. 1968;206(11):2518-2520. doi:10.1001/jama.1968.03150110066017