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 patient is asked to lie down at 30 degrees with his/her head tilted 45 degrees to the left. Then an oblique light is used to illuminate the jugular region of the neck to help in identifying the inner jugular vein. Care must be taken not to confuse it with the external jugular, whose beating is more easily seen under the skin due to it being more superficial. In patients with severe right heart congestion, observation of the inner jugular might not be feasible due to its distention all the way into the upper neck and skull.

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 swelling of 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. 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. 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.