Abdominojugular test

The abdominojugular test or abdominojugular reflux (AJR, historically known by the incorrect term "hepatojugular reflux"), is a test for measuring jugular venous pressure (JVP) through the distension or swelling of the internal jugular vein. A positive AJR test correlates with the pulmonary artery pressure and thus is a marker for right heart dysfunction,[1] specifically right ventricular failure.[2]

Procedure

The clinician presses firmly over either the right upper quadrant of the abdomen (i.e., over the liver) or over the center of the abdomen [1] for 10 seconds with a pressure of 20 to 35 mm Hg while observing the internal jugular vein in the neck and also observing to be sure the patient does not perform a Valsalva maneuver.[3]

On an otherwise healthy individual, the jugular venous pressure remains constant or temporarily rises for a heartbeat or two, before returning to normal. This negative result would be indicated by a lack of swelling of the jugular vein. Negative abdominojugular reflux is seen in Budd-Chiari syndrome.

A positive result is variously defined as either a sustained rise in the JVP of at least 4 cm or more [3] or a fall of 4 cm or more [1] after the examiner releases pressure. The AJR has a reported sensitivity of 24% [4] to 72% [1] and a specificity of 93% to 96%. The large discrepancy in sensitivity may be explained by the higher value being reported during performance in optimal conditions of a cardiac lab while the lower value was from a study in an emergency room.

References

  1. 1 2 3 4 Ewy G (1988). "The abdominojugular test: technique and hemodynamic correlates". Ann Intern Med 109 (6): 456–60. doi:10.7326/0003-4819-109-6-456. PMID 3415106.
  2. ↑ The abdominojugular reflux sign., Wiese, J. Am J Med. 2000 Jul;109(1):59-61.
  3. 1 2 Cook D, Simel D (1996). "The Rational Clinical Examination. Does this patient have abnormal central venous pressure?". JAMA 275 (8): 630–4. doi:10.1001/jama.1996.03530320054034. PMID 8594245.
  4. ↑ Marantz P, Kaplan M, Alderman M (1990). "Clinical diagnosis of congestive heart failure in patients with acute dyspnea". Chest 97 (4): 776–81. doi:10.1378/chest.97.4.776. PMID 2182296.
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