Liver measurement and normal value

General Ultrasound Liver Measurements

Liver measurement and normal value

Normal Value

Liver Meassurement General Sonography Updated 2026 Educational Reference

Hepatic — Measurable Structures

Distance measurement

• Span (MCL)
• LL AP diameter
• CL AP diameter
• Glosus capsul thicnes
• Portal vein dia.
• Hepatic vein dia.
• CBD dia.
• Lesion: L × W × T

Volume measurement

• Liver Volume
• Lesion Volume

Area measurement

• Lesion Area trase

Vascular Structures

• HV Doppler
• PV Doppler

Distance measurement →
Span (MCL): Liver span at the Mid-Clavicular Line (MCL) is the craniocaudal length of the right hepatic lobe measured in centimeters along the right mid-clavicular line on ultrasound, from the superior hepatic margin to the inferior liver margin.

Liver span measures approximately 13.5 cm along the right mid-clavicular line (MCL), within normal limits.

Normal Ultrasound Mid-Clavicular Length of Liver by Age

Newborns and Infants (0-2 years):	40-100mm
Children (3-8 years):	65-120mm
(9-12 years):	75-130mm
Adolescents (13-18 years):	85-140mm
Adults (18+ years):	95-145mm

LL AP diameter:The left lobe anteroposterior (AP) diameter is the maximum thickness of the left hepatic lobe measured in centimeters on ultrasound, typically obtained in the sagittal plane from the anterior to posterior margin of the left lobe.
Normal Ultrasound Left Lobe (LL) AP Diameter by Age

Newborns and Infants (0-2 years):	15-35mm
Children (3-8 years):	25-50mm
(9-12 years):	35-55mm
Adolescents (13-18 years):	45-65mm
Adults (18+ years):	50-70mm

CL AP Diameter: The caudate lobe anteroposterior (AP) diameter is the maximum thickness of the caudate lobe measured in centimeters on ultrasound, typically obtained in the sagittal or transverse plane from the anterior to posterior margin of the caudate lobe.
Normal Ultrasound Mid-Clavicular (CL) AP Diameter of Right Lobe by Age

Newborns and Infants (0-2 years):	30-60mm
Children (3-8 years):	50-80mm
(9-12 years):	65-95mm
Adolescents (13-18 years):	80-110mm
Adults (18+ years):	90-120mm

Glisson's Capsule Thickness: The thickness of Glisson's capsule is the measured thickness of the fibrous connective tissue capsule surrounding the liver, assessed in millimeters on ultrasound.
Normal Ultrasound Glisson's Capsule Thickness by Age

Newborns and Infants (0-2 years):	0.03-0.05mm (30-50 µm)
Children (3-8 years):	0.04-0.06mm (40-60 µm)
(9-12 years):	0.05-0.07mm (50-70 µm)
Adolescents (13-18 years):	0.06-0.08mm (60-80 µm)
Adults (18+ years):	0.07-0.10mm (70-100 µm)

Portal Vein Diameter: The portal vein diameter is the maximum internal diameter of the main portal vein measured in millimeters on ultrasound, typically assessed near the porta hepatis.
Normal Ultrasound Portal Vein Diameter by Age

Newborns and Infants (0-2 years):	3-6mm
Children (3-8 years):	5-8mm
(9-12 years):	7-10mm
Adolescents (13-18 years):	8-12mm
Adults (18+ years):	9-13mm

Hepatic Vein Diameter: The hepatic vein diameter is the internal diameter of the hepatic vein measured in millimeters on ultrasound, usually assessed near its entry into the inferior vena cava.
Normal Ultrasound Hepatic Vein Diameter by Age

Newborns and Infants (0-2 years):	2-4mm
Children (3-8 years):	3-5mm
(9-12 years):	4-6mm
Adolescents (13-18 years):	5-7mm
Adults (18+ years):	5-8mm

CBD Diameter: The common bile duct (CBD) diameter is the maximum internal diameter of the common bile duct measured in millimeters on ultrasound, typically assessed at the porta hepatis.
Normal Ultrasound Common Bile Duct (CBD) Diameter by Age

Newborns (<1 month):	<1mm
Infants (1 month - 1 year):	<2mm
Children (1-10 years):	<3mm
Older Children & Adolescents (10-18 years):	<4mm
Adults (<60 years):	<6mm
Elderly Adults (≥60 years):	<8mm (up to ~10mm)

Lesion: L × W × T: Lesion dimensions represent the maximum length (L), width (W), and thickness (T) of a focal hepatic lesion measured in centimeters on ultrasound, recorded in three orthogonal dimensions.

Volume measurement → Liver Volume
Normal Ultrasound Liver Volume by Age

Newborns and Infants (0-2 years):	100-300 mL
Children (3-8 years):	400-700 mL
(9-12 years):	600-1000 mL
Adolescents (13-18 years):	800-1400 mL
Adults (18+ years):	1060-2223 mL

Lesion Volume

Lesion Area Trase → :

Vascular structure →
HV Doppler
Normal Hepatic Vein (HV) Doppler Waveform by Age

Newborns and Infants (0-2 years):	Monophasic or biphasic common (normal variant); S wave 10-20 cm/s
Children (3-8 years):	Triphasic in most; S wave 15-25 cm/s; S ≥ D
(9-12 years):	Triphasic; S wave 20-30 cm/s; S ≥ D
Adolescents (13-18 years):	Triphasic (~80%); S wave 20-30 cm/s; S ≥ D
Adults (18+ years):	Triphasic (~80%); S wave 25-35 cm/s; S ≥ D; peak velocity >10 cm/s

Hepatic Vein Doppler — Normal Adult Values

Parameter	Normal value (adult)	Notes
Peak S-wave velocity	20–50 cm/s	Systolic forward flow; dominant forward wave
Peak D-wave velocity	10–30 cm/s	Diastolic forward flow; usually smaller than S
Peak A-wave (reversal) velocity	≤ 10–15 cm/s	Small brief reversal is normal; prominent reversal is abnormal
V-wave (end-systolic reversal)	≤ 5–10 cm/s (often absent)	May be seen normally as a small notch
S/D ratio	> 1 (typically 1.5–2.5)	S wave larger than D wave; reversal (S < D) suggests elevated RA pressure
A-wave reversal duration	< 20–30 ms	Brief reversal is normal; prolonged reversal indicates elevated RA pressure

PV Doppler
Normal Portal Vein (PV) Doppler by Age

Newborns and Infants (0-2 years):	Hepatopetal; PSV 15-30 cm/s (lower cut-off: 10 cm/s preterm, 15 cm/s term)
Children (3-8 years):	Hepatopetal; PSV 14-41 cm/s (median ~26 cm/s)
(9-12 years):	Hepatopetal; PSV 14-41 cm/s (median ~26 cm/s)
Adolescents (13-18 years):	Hepatopetal; PSV 15-40 cm/s (median ~26 cm/s)
Adults (18+ years):	Hepatopetal; PSV 20-40 cm/s (mean ~19-21 cm/s)

Portal Vein Doppler — Normal Adult Values

Parameter	Normal value (adult)	Notes
Peak systolic velocity (S)	15–40 cm/s	Hepatopetal flow (toward liver); mild respiratory variation
Peak diastolic velocity (D)	10–30 cm/s	Usually slightly lower than systolic; flow remains hepatopetal
Mean flow velocity	15–25 cm/s	Time-averaged mean velocity; used to calculate flow volume
Pulsatility index (PI)	0.5–1.2	Reflects phasicity; low PI suggests loss of pulsatility
Flow volume	600–1200 mL/min	Varies with body size and cardiac output
Flow direction	Hepatopetal (toward liver)	Reversal (hepatofugal) indicates portal hypertension or steal phenomenon
Phasicity	Mild phasic (follows respiration)	Loss of phasicity suggests liver disease or venous congestion
Variance (S/D)	1.0–2.0	Increased variance suggests elevated hepatic venous pressure

Murphy's Sign (Sweeney's Sign)

General Ultrasound • Gallbladder • Clinical Signs

Murphy's Sign (Sweeney's Sign)

Clinical Elicitation, Sonographic Correlation, and Significance in Gallbladder Disease

Hepatobiliary Ultrasound General Sonography Updated 2026 Educational Reference

Definition → Murphy's sign, also known as Sweeney's sign, is a clinical sign used primarily to assess for gallbladder inflammation, particularly acute cholecystitis. A positive sign occurs when palpation of the right upper quadrant during inspiration produces significant pain and causes the patient to abruptly stop or interrupt inspiration.

How is it Elicited? → The examiner places the fingers or hand beneath the right costal margin, usually near the midclavicular line, and asks the patient to take a deep breath. During inspiration, the diaphragm moves downward and the gallbladder descends toward the examiner's hand. If this maneuver produces marked pain and the patient suddenly stops inspiration, the test is considered positive.

Positive Murphy's Sign → A positive Murphy's sign is characterized by localized right upper quadrant tenderness associated with inspiratory arrest. The finding suggests gallbladder inflammation and may support the clinical diagnosis of acute cholecystitis, but it should always be interpreted together with the clinical presentation and imaging findings.

Sweeney's Sign → Sweeney's sign is used as a synonym for Murphy's sign. Therefore, a positive Sweeney's sign describes the same clinical response: right upper quadrant pain during inspiration with inspiratory arrest when the inflamed gallbladder comes into contact with the examiner's hand.

Ultrasound Murphy's Sign → During ultrasound examination, the transducer is positioned directly over the gallbladder and gentle pressure is applied. A sonographic Murphy's sign is considered positive when the patient experiences maximal tenderness directly beneath the ultrasound probe over the gallbladder. This finding is particularly useful when correlated with gallbladder wall thickening, distension, stones, sludge, or pericholecystic fluid.

Clinical Importance → Murphy's sign is an important bedside finding in patients with suspected acute cholecystitis. It helps localize symptoms to the gallbladder, but a positive or negative sign alone does not establish or exclude the diagnosis. Clinical examination, laboratory findings, and imaging should be considered together.

Sonographic Correlation → In suspected acute cholecystitis, ultrasound may demonstrate gallstones, gallbladder distension, wall thickening, pericholecystic fluid, sludge, hyperemia of the gallbladder wall, and a positive sonographic Murphy's sign. The combination of appropriate clinical findings and characteristic sonographic abnormalities increases diagnostic confidence.

Positive vs Negative → Positive Murphy's Sign → Right upper quadrant pain + inspiratory arrest.
Negative Murphy's Sign → Deep inspiration can be completed without characteristic gallbladder tenderness.
Sonographic Murphy's Sign → Maximal tenderness directly beneath the ultrasound transducer over the gallbladder.

Commonly Associated Conditions → Murphy's sign is most classically associated with acute cholecystitis. Similar right upper quadrant tenderness, however, may occur with other hepatobiliary or adjacent abdominal conditions, so the sign is not completely specific for acute cholecystitis.

Important Ultrasound Findings → Gallstones → Echogenic calculi with posterior acoustic shadowing.
Gallbladder Wall Thickening → May accompany inflammation but is nonspecific.
Gallbladder Distension → May occur with cystic duct obstruction.
Pericholecystic Fluid → Supports inflammatory change when appropriately interpreted.
Wall Hyperemia → May be demonstrated with Doppler in inflammation.
Sonographic Murphy's Sign → Maximal tenderness directly over the gallbladder.

Clinical Mechanism → During deep inspiration, the diaphragm descends and the gallbladder moves downward toward the examiner's hand or ultrasound transducer. When the gallbladder is inflamed, this contact can produce localized pain, causing the patient to interrupt inspiration.

Key Learning Point → Murphy's Sign = Sweeney's Sign
Positive Clinical Sign = RUQ pain + inspiratory arrest
Sonographic Murphy's Sign = Maximal tenderness directly beneath the probe over the gallbladder
Most Important Association = Acute cholecystitis

Did You Know? → John Benjamin Murphy's influence extended beyond the Murphy sign. He was an important figure in the development of modern American surgery, particularly through his emphasis on early intervention, clinical observation, surgical innovation, and practical teaching. The American College of Surgeons recognizes him as one of the important figures in its early history.

Historical Summary → John Benjamin Murphy → American surgeon
Born → December 21, 1857, Appleton, Wisconsin
Medical Degree → Rush Medical College, 1879
Major Surgical Center → Chicago
Chief of Surgery → Mercy Hospital, Chicago
Famous For → Murphy's sign + major surgical innovations
American Medical Association → President, 1911–1912
Died → August 11, 1916