POCUS – Transhepatic IVC View

The traditional way of assessing the inferior vena cava (IVC) with point-of-care ultrasound (POCUS) is longitudinally from a subcostal window; however, this can be challenging when that area is off limits (subcostal chest tubes, burn injuries, etc.)

The transhepatic IVC view is obtained by placing a phased array probe (oriented cephalad-caudad) in the right upper abdominal quadrant and sliding cranially while tilting the beam posteriorly. In this video, one initially appreciates the liver and right kidney with Morison’s pouch in between. As the probe is slid cranially, the IVC and aorta come into view. Just like any view, it’s important to verify structures based on anatomic relationships – in this case, hepatic veins are seen emptying into the IVC.

The data has shown that there is poor agreement between the transhepatic and subcostal IVC measurements – indices cannot be applied equally to the two techniques. In general, IVC diameter and respirophasic variation rarely guide my clinical practice outside the extremes. Still, it’s a topic that comes up all the time in the world of ultrasonography!

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