American Journal of the Medical Sciences
Venous Murmurs in Cirrhosis of the Liver.-Investigations by G. Catti (Ztsclir. f. klin. Med., 1907, lxi, 269) have shown that venous murmurs adible over and in the neighborhood of the spleen are relatively common in cirrhosis of the liver, occurring in one-fifth to one-sixth of all the eases; murmurs audible elsewhere, as in the epigastrium, near the xiphoid, above the umbilicus, etc., are very uncommon and are still unexplained. His first patient had hepatic cirrhosis to a marked degree; the
... arked degree; the veins about the umbilicus were somewhat dilated, those of the rest of the abdomen very markedly. The xiphoid, mammary, and inferior epi¬ gastric veins wrere markedly dilated and connected by a number of branches. Several centimeters to the left of the umbilicus the hand could feel an intense thrill, most marked over the left inferior epigastric vein; it was easily heard over the entire abdomen, but varied in intensity and character in different places. Compression of the left epigastric vein below the point of greatest intensity caused a disappearance of the murmur; below this point the vein was narrower than farther up. The murmur was evidently caused by the blood flowing suddenly from the relatively narrow inferior epigastric vein into the more dilated superior epigastric vein; the junction of the deep and superficial inferior epi¬ gastric was immediately below this point, increasing the pressure, and the blood pressure was still farther increased by the stasis in the portal vein. In the case of his second patient a venous murmur wras audible but not palpable immediately below' the ensiform; it was transmitted upward along the sternum. The cause of this lie found in the junction of the para-umbilical veins, or probably of the termination of the umbili¬ cal vein in the larger xiphoid vein, or finally of the deep left epigastric vein into the para-umbilical veins. These murmurs, therefore, are due to the blood flow iug under considerable pressure from a relatively narrow vein into a larger one, in which the pressure is considerably low'er; they are murmurs of stenosis.