Position

The subject is in decubitus. Place yourself on the side of the renal artery in question.

Method

Your cephalad hand contacts the paravertebral mass opposite the renal area, in the neighborhood of the 12th rib, and maintains a posteroanterior pressure throughout the duration of the search (Fig. 30.2). Place three or four fingers of your caudal hand juxtaposed to the lateral border of the rectus abdominis muscle, slightly above the umbilicus. Slowly progress towards the anterior surface of the lumbar wall, first in a purely sagittal direction and then slightly oblique and medial, until you meet the anterior lateral surface of the psoas muscle.

Fig. 30.2 Palpation of the renal artery.

Glide your fingers longitudinally along the psoas, looking for an arterial pulse, perpendicular to the main axis of the psoas. As a rule you will capture this pulsation under one fingerpad only.

Stay sufficiently lateral to the abdominal aorta. You will feel a distinct pulse, almost perpendicular to the aortic axis. Oriented posterior and lateral to the psoas, the artery is of a significant caliber. It is obviously larger than the pancreaticoduodenal branches of the celiac trunk and the middle colic artery accompanying the transverse colon.

Palpation of the renal artery clearly illustrates the phenomenon referred to as principle of the concealing pulse. In this particular region, the hand is easily ‘dazzled’ by the pulsations of the larger vessels. Typically the biggest pulse can be felt clearly, even when it lies deep to the more slender ones.