Abdominojugular test

The abdominojugular test (AJR), also known as hepatojugular reflux, is used as an alternate test for measuring jugular venous pressure (JVP) through the distension or swelling of the internal jugular vein. A positive AJR best correlates with the pulmonary artery pressure and thus is a marker for right heart dysfunction.

Procedure
The doctor presses firmly over either the right upper quadrant of the abdomen (i.e., over the liver) or over the center of the abdomen 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.

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 hepatojugular 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 or a fall of 4 cm or more after the examiner releases pressure. The AJR has a reported sensitivity of 24% to 72% 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.