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April 6, 1979

The Importance of a Coexistent Hepatic Rub and BruitA Clue to the Diagnosis of Cancer in the Liver

Author Affiliations

From the Medical Service, Atlanta Veterans Administration Medical Center, Decatur, Ga, and the Department of Medicine, Emory University School of Medicine, Atlanta.

JAMA. 1979;241(14):1495. doi:10.1001/jama.1979.03290400055025

FRICTION rubs heard over the liver result from inflammation or necrosis.1,2 Hepatic rubs may occur in metastatic cancer,3 gonococcal perihepatitis,4 alcoholic cirrhosis,1 pyogenic abscess,1,5 bile duct carcinoma, viral hepatitis, perihepatitis secondary to systemic lupus erythematosus, cholecystitis, and tuberculous peritonitis.1

Hepatic arterial bruits have been reported to occur in malignant hepatoma, metastatic cancer of the liver, and alcoholic hepatitis.6

We postulated the presence of a hepatic rub and bruit in the same patient would be indicative of a malignant neoplasm in the liver.

Patients and Methods  Approximately 1,000 patients were examined the morning after their admission to general medical wards at the Veterans Administration Hospital and Grady Memorial Hospital during a two-month period. Auscultation was carried out in four quadrants of the abdomen to detect rubs and bruits. Organomegaly was determined by palpation.


Bruits From Large Vessels.—  Four patients without hepatomegaly had systolic