Subcostal Great Vessels
Transducer Position: Rotate the probe 90 degrees counter clockwise from the 4 chamber subcostal view
so that the probe is pointing toward the head at 12'o'clock (arrow). Tilting medially and laterally will help
show the IVC and aorta
Inferior Vena Cava
To get this view, tilt the probe more right lateral from the abdominal aorta view. Alternatively from the subcostal four chamber, visualize the right atrium and turn the probe from the 9 o'clock position to the 12 o'clock position. This view is used to assess RA pressures based on inspiratory collapse of the IVC. Lack of collapse suggests high RA pressures where as complete collapse suggests low RA pressures. Note the change here in IVC diameter with respiration. Sometimes an M mode through the IVC as shown above on the right can better help show respiratory changes with time. This topic is covered further in the hemodynamics section.
Slight angulation around the IVC position will show the middle hepatic vein, shown above with color Doppler PW can then be done to reveal the characteristic waveform which gives information about right sided pressures and hemodynamics as there is no valve between the middle hepatic vein and the right atrium. Shown are the A wave (atrial contraction), S wave (systole) and D wave (diastole). Reversal of the S wave may be seen with significant tricuspid regurgitation.
The abdominal aorta can be found by tilting the probe medially until this pulsatile thick-walled structure is seen. This view assesses the abdominal aorta from which the celiac artery can sometimes be seen to arise. PW can be performed here although blood flow may sometimes be quite perpendicular to the transducer.