Longitudinal Scanning of the Liver Through the Middle Hepatic Vein on Subxiphoid

Longitudinal liver section • Middle Hepatic Vein • Subxiphoid approach

Scanning Method

The patient should be fasted for 8–12 hours and examined in the supine position. Place the ultrasound probe vertically in the midline at the subxiphoid region. Direct the probe to obtain a longitudinal section of the liver through the middle hepatic vein (MHV). Adjust the probe angle and depth to clearly demonstrate the liver parenchyma, MHV, and relevant adjacent anatomical structures.

Key scanning point: Begin from the subxiphoid midline with the probe oriented longitudinally. Identify the middle hepatic vein (MHV) as the principal anatomical landmark and adjust the probe position to obtain a clear longitudinal view of the liver through the MHV.

Ultrasound Image

Figure 1.1 Longitudinal section of the liver through the middle hepatic vein (MHV) on subxiphoid scanning. Insert the corresponding ultrasound image in the space above.

Anatomical / Scanning Diagram

Figure 1.2: Diagram space showing the probe orientation, scanning plane, liver, middle hepatic vein (MHV), and labeled anatomical landmarks.

Section Structure

The principal structures demonstrated in this plane are the right lobe of the liver (RL), the middle hepatic vein (MHV), the right portal vein (RPV), the right hepatic duct (RHD), the common hepatic duct (CHD), the gallbladder (Gb), the pylorus (PH), and the inferior vena cava (IVC). The middle hepatic vein serves as an important vascular landmark for confirming the correct longitudinal orientation of the liver.

Structures to identify

• Right lobe of the liver (RL)
• Middle hepatic vein (MHV)
• Right portal vein (RPV)
• Right hepatic duct (RHD)
• Common hepatic duct (CHD)
• Gallbladder (Gb)
• Pylorus (PH)
• Inferior vena cava (IVC)
• Hepatic parenchyma
• Adjacent upper abdominal structures

Abbreviations Used in the Figure

Abbreviation	Full form	Identification
RL	Right Lobe of Liver	Main hepatic parenchymal component demonstrated in the scan.
CHD	Common Hepatic Duct	Biliary structure within the porta hepatis.
RHD	Right Hepatic Duct	Biliary duct draining the right hepatic lobe.
RPV	Right Portal Vein	Portal venous branch supplying the right hepatic lobe.
MHV	Middle Hepatic Vein	Major hepatic vein coursing through the liver toward the IVC.
Gb	Gallbladder	Gallbladder visualized adjacent to the right hepatic lobe.
PH	Pylorus	Pyloric portion of the stomach visualized adjacent to the liver.
IVC	Inferior Vena Cava	Major venous landmark posterior to the liver.

Measuring Method and Normal

When clinically indicated, assess the middle hepatic vein (MHV) along its visualized longitudinal course. Evaluate its caliber, continuity, and relationship to the inferior vena cava (IVC). Doppler assessment may be used to evaluate hepatic venous patency and flow characteristics.

Measurement	Caliper method	Reference / interpretation
Middle hepatic vein (MHV)	Measure the vessel caliber perpendicular to its long axis when a quantitative measurement is clinically indicated.	Document the measurement together with the sonographic appearance and Doppler flow characteristics when indicated.

Measurement note: Keep the MHV clearly visualized along its longitudinal course toward the IVC. Avoid including surrounding hepatic parenchyma or adjacent vascular structures in the measurement.

The Clinical Application Value

This plane provides a useful longitudinal view of the liver through the middle hepatic vein (MHV). It permits assessment of the right hepatic lobe (RL), MHV, right portal vein (RPV), right hepatic duct (RHD), common hepatic duct (CHD), gallbladder (Gb), pylorus (PH), and inferior vena cava (IVC) in a standardized subxiphoid orientation.

• Demonstration of the right hepatic lobe (RL) in longitudinal section.
• Identification of the middle hepatic vein (MHV) as the principal vascular landmark.
• Visualization of the MHV extending toward the IVC.
• Assessment of the right portal vein (RPV).
• Identification of the right hepatic duct (RHD) and common hepatic duct (CHD).
• Assessment of the gallbladder (Gb).
• Visualization of the pylorus (PH) when included in the scanning plane.
• Identification of the IVC as an important posterior vascular landmark.
• Assessment of liver size, contour, and parenchymal echogenicity.

Quick Scanning Checklist

1	Fast the patient for 8–12 hours when appropriate.
2	Position the patient supine.
3	Place the probe at the subxiphoid region.
4	Orient the probe longitudinally to obtain the liver section through the MHV.
5	Identify the RL as the main hepatic structure.
6	Identify the MHV and follow it toward the IVC.
7	Identify the RPV, RHD, and CHD.
8	Identify the Gb and PH when visualized.
9	Assess the MHV and IVC with Doppler when clinically indicated.
10	Assess the liver, biliary structures, gallbladder, and adjacent anatomy for abnormalities.

Diagnostic Pathology

The longitudinal subxiphoid view through the middle hepatic vein (MHV) can assist in identifying hepatic, vascular, biliary, and adjacent upper abdominal abnormalities. Evaluate the RL, MHV, RPV, RHD, CHD, Gb, PH, and IVC for abnormal findings.

Key Sonographic Findings

• Right hepatic lobe enlargement: Increased size or altered morphology of the right hepatic lobe.
• Hepatic steatosis: Increased parenchymal echogenicity with reduced visualization of deeper hepatic structures.
• Cirrhotic liver: Coarse hepatic echotexture, irregular or nodular contour, and altered hepatic morphology.
• Focal liver lesion: Focal abnormality differing in echogenicity or architecture from the surrounding hepatic parenchyma.
• Middle hepatic vein abnormality: Altered caliber, abnormal course, narrowing, or nonvisualization of the MHV.
• Hepatic venous thrombosis: Intraluminal material with partial or complete loss of normal venous flow, when demonstrated.
• Portal vein abnormality: Altered caliber, intraluminal material, thrombosis, or abnormal Doppler flow involving the RPV.
• Biliary duct abnormality: Dilatation or altered appearance of the RHD or CHD.
• Gallbladder abnormality: Gallbladder distension, wall thickening, sludge, calculi, or focal intraluminal abnormality when visualized.
• IVC abnormality: Abnormal caliber, narrowing, intraluminal material, or altered appearance of the IVC.
• Pyloric abnormality: Altered wall appearance, thickening, distension, or abnormal contents involving the pylorus when adequately visualized.

Diagnostic note: Abnormal findings should be interpreted together with the complete abdominal ultrasound examination, Doppler assessment, clinical history, and laboratory findings. A single sonographic sign should not be used in isolation to establish a diagnosis.

Oblique Scanning of the Right Liver Through the Porta Hepatis

Oblique right liver section • Porta Hepatis • Subxiphoid approach

Scanning Method

The patient should be fasted for 8–12 hours and examined in the supine position. Place the ultrasound probe obliquely in the upper abdominal or subxiphoid region. Direct the probe to obtain an oblique section of the right liver through the porta hepatis. Adjust the probe angle and depth to clearly demonstrate the right hepatic parenchyma, porta hepatis, and relevant adjacent anatomical structures.

Key scanning point: Begin from the subxiphoid/upper abdominal region with the probe oriented obliquely. Identify the porta hepatis as the principal anatomical landmark and adjust the probe position and angulation to obtain a clear oblique view of the right liver through the porta hepatis.

Ultrasound Image

Figure 1.1 Oblique section of the right liver through the porta hepatis on subxiphoid scanning. Insert the corresponding ultrasound image in the space above.

Anatomical / Scanning Diagram

Figure 1.2: Diagram space showing the probe orientation, scanning plane, right liver, porta hepatis, and labeled anatomical landmarks.

Section Structure

The principal structures demonstrated in this plane are the right lobe of the liver (RL), the right portal vein (RPV), the portal vein (PV), the common hepatic duct (CHD), the gallbladder (Gb), and the inferior vena cava (IVC). The portal venous structures and porta hepatis serve as important anatomical landmarks for confirming the correct oblique orientation.

Structures to identify

• Right lobe of the liver (RL)
• Right portal vein (RPV)
• Portal vein (PV)
• Common hepatic duct (CHD)
• Gallbladder (Gb)
• Inferior vena cava (IVC)
• Hepatic parenchyma
• Porta hepatis
• Adjacent upper abdominal structures

Abbreviations Used in the Figure

Abbreviation	Full form	Identification
RL	Right Lobe of Liver	Main hepatic parenchymal component demonstrated in the scan.
RPV	Right Portal Vein	Portal venous branch supplying the right hepatic lobe.
IVC	Inferior Vena Cava	Major venous landmark posterior/inferior to the liver.
Gb	Gallbladder	Gallbladder visualized adjacent to the right hepatic lobe and porta hepatis.
CHD	Common Hepatic Duct	Biliary structure visualized within the porta hepatis.
PV	Portal Vein	Main portal venous structure within the porta hepatis.

Measuring Method and Normal

When clinically indicated, assess the portal vein (PV) and right portal vein (RPV) in the appropriate oblique plane. The vessel should be clearly visualized, and measurements should be obtained perpendicular to the vessel walls while avoiding adjacent structures. Doppler assessment may be used to evaluate portal venous flow, direction, and patency.

Measurement	Caliper method	Reference / interpretation
Portal vein (PV) diameter	Measure the portal vein perpendicular to its long axis from inner wall to inner wall in a clearly visualized segment.	Document the measurement together with the sonographic appearance and Doppler flow characteristics when indicated.

Measurement note: Keep the PV clearly visualized, place the calipers perpendicular to the vessel walls, and avoid including the adjacent CHD or surrounding soft tissues in the measurement.

The Clinical Application Value

This plane provides a useful oblique view of the right liver through the porta hepatis. It permits assessment of the right hepatic lobe (RL), right portal vein (RPV), portal vein (PV), common hepatic duct (CHD), gallbladder (Gb), and inferior vena cava (IVC) in a standardized upper abdominal orientation.

• Demonstration of the right hepatic lobe (RL).
• Identification of the right portal vein (RPV).
• Visualization of the main portal vein (PV) within the porta hepatis.
• Identification of the common hepatic duct (CHD).
• Assessment of the gallbladder (Gb) and its relationship to the porta hepatis.
• Identification of the IVC as an important vascular landmark.
• Assessment of the right hepatic parenchyma and liver contour.
• Evaluation of portal venous flow with Doppler when clinically indicated.

Quick Scanning Checklist

1	Fast the patient for 8–12 hours when appropriate.
2	Position the patient supine.
3	Place the probe in the upper abdominal/subxiphoid region.
4	Angle the probe obliquely to obtain the right liver view through the porta hepatis.
5	Identify the RL as the main hepatic structure.
6	Identify the RPV and PV within the porta hepatis.
7	Identify the Gb and CHD.
8	Identify the IVC and assess the liver, portal structures, and gallbladder for abnormalities.

Diagnostic Pathology

The oblique view of the right liver through the porta hepatis provides a useful assessment of the RL, RPV, PV, CHD, Gb, and IVC. Evaluate the right hepatic parenchyma, portal venous structures, biliary structures, gallbladder, and IVC for abnormal findings.

Key Sonographic Findings

• Right hepatic lobe enlargement: Increased size or altered morphology of the right hepatic lobe.
• Hepatic steatosis: Increased parenchymal echogenicity with reduced visualization of deeper hepatic structures.
• Cirrhotic liver: Coarse hepatic echotexture, irregular or nodular contour, and altered hepatic morphology.
• Focal liver lesion: Focal abnormality differing in echogenicity or architecture from the surrounding right hepatic parenchyma.
• Portal vein abnormality: Altered caliber, intraluminal material, thrombosis, or abnormal Doppler flow within the PV or RPV.
• Portal vein thrombosis: Intraluminal material with partial or complete loss of normal portal venous flow, when demonstrated.
• Common hepatic duct abnormality: Abnormal caliber, wall appearance, or dilatation of the CHD.
• Gallbladder abnormality: Gallbladder distension, wall thickening, sludge, calculi, or focal intraluminal abnormalities when visualized.
• IVC abnormality: Abnormal caliber, narrowing, intraluminal material, or altered appearance of the IVC.
• Porta hepatis abnormality: Altered relationship, displacement, compression, or abnormal appearance of the portal and biliary structures.

Diagnostic note: Abnormal findings should be interpreted together with the complete abdominal ultrasound examination, Doppler assessment, clinical history, and laboratory findings. A single sonographic sign should not be used in isolation to establish a diagnosis.