Longitudinal Scanning of the Hepatic Left Lobe and the Ligamentum Teres Hepatis by Subxiphoid

Longitudinal liver section • Hepatic Left lobe • Ligamentum Teres Hepatis by Subxiphoid approach

Scanning Method

The patient should be fasted for 8–12 hours and examined in the supine position. Place the ultrasound probe longitudinally in the subxiphoid region, with the transducer directed toward the left upper abdomen. Orient and angle the probe to obtain a clear longitudinal section of the left hepatic lobe and to demonstrate the ligamentum teres hepatis along with the adjacent hepatic and vascular landmarks.

Key scanning point: Begin from the subxiphoid region with the probe placed in a longitudinal orientation and directed toward the left hepatic lobe. Adjust the probe orientation, angle, depth, and pressure to obtain a well-defined longitudinal view of the hepatic parenchyma. The ligamentum teres hepatis should be identified within the expected fissural region, with attention to its relationship to the left hepatic lobe and adjacent vascular structures.

Ultrasound Image

Figure 1.1 Longitudinal section of the hepatic left lobe and ligamentum teres hepatis obtained by subxiphoid scanning. Insert the corresponding ultrasound image in the space above.

Anatomical / Scanning Diagram

Figure 1.2: Diagram showing the longitudinal probe orientation, subxiphoid scanning plane, hepatic left lobe, ligamentum teres hepatis, and relevant adjacent anatomical landmarks.

Section Structure

The principal structures demonstrated in this plane are the quadrate lobe (QL), caudate lobe (CL), left hepatic vein (LHV), portal vein (PV), ligamentum teres hepatis (LTH), and venous ligament (VL). The numbered structure 1 is also demonstrated as indicated in the figure.

Structures to identify

• Quadrate lobe (QL)
• Left Portal Vein (1)
• Left hepatic vein (LHV)
• Ligamentum teres hepatis (LTH)
• Portal vein (PV)
• Venous ligament / ligamentum venosum (VL)
• Caudate lobe (CL)
• Hepatic parenchyma

Abbreviations Used in the Figure

Short form	Full form	Identification
QL	Quadrate lobe	Quadrate lobe of the liver.
1	Numbered structure	Umbilical and sagittal section of the left portal vein
LHV	Left hepatic vein	Left hepatic vein within the left hepatic lobe.
LTH	Ligamentum teres hepatis	Fibrous remnant of the fetal umbilical vein.
PV	Portal vein	Portal venous structure demonstrated within the hepatic hilum.
VL	Venous ligament	Ligamentum venosum located between the left hepatic and caudate regions.
CL	Caudate lobe	Caudate lobe of the liver.

Measuring Method and Normal

This subxiphoid longitudinal plane is primarily used for anatomical identification and assessment of the hepatic structures. When measurement is clinically indicated, the target structure should be clearly visualized and measured using an appropriate standardized ultrasound technique.

Structure	Assessment method	Reference / interpretation
QL	Assess size, contour, echogenicity, and internal echotexture.	Interpret in relation to the surrounding hepatic parenchyma.
CL	Assess caudate lobe size, contour, and echogenicity.	Evaluate for enlargement or focal structural abnormality.
LHV	Assess vessel caliber, patency, course, and Doppler flow when required.	Interpret together with the other hepatic veins and portal venous system.
PV	Assess caliber, course, lumen, and Doppler flow when indicated.	Evaluate for patency, altered flow, or thrombotic change.
LTH	Identify the ligamentum teres hepatis within the expected fissural region.	Assess its location and relationship to adjacent hepatic structures.
VL	Identify the venous ligament and its relationship to the left and caudate lobes.	Assess its expected anatomical position and appearance.

Measurement note: Keep the target structure clearly visualized and avoid including adjacent structures when obtaining measurements.

Clinical Application Value

This subxiphoid longitudinal plane provides an important anatomical view of the hepatic left-sided structures and demonstrates the relationship between the QL, LHV, LTH, PV, VL, and CL.

• Demonstration of the quadrate lobe (QL).
• Identification of the left hepatic vein (LHV).
• Identification of the ligamentum teres hepatis (LTH).
• Visualization of the portal vein (PV).
• Recognition of the venous ligament (VL).
• Identification and assessment of the caudate lobe (CL).
• Assessment of hepatic parenchymal echogenicity and contour.
• Evaluation of the anatomical relationships between the hepatic vascular and ligamentous structures.

Quick Scanning Checklist

1	Fast the patient for 8–12 hours when appropriate.
2	Position the patient supine.
3	Place the probe longitudinally in the subxiphoid region.
4	Direct the probe toward the left hepatic lobe.
5	Obtain a clear longitudinal view of the hepatic parenchyma.
6	Identify QL, LHV, LTH, PV, VL, and CL.
7	Identify the numbered structure 1.
8	Assess hepatic contour and parenchymal echogenicity.
9	Use Doppler when vascular characterization of the LHV or PV is required.

Diagnostic Pathology

This subxiphoid longitudinal view can assist in assessing the hepatic parenchyma, hepatic veins, portal venous structures, and hepatic ligamentous landmarks. The QL, LHV, LTH, PV, VL, and CL should be evaluated together with the surrounding hepatic anatomy.

Key Sonographic Findings

• Hepatomegaly: Increased hepatic size with alteration of normal contour or morphology.
• Hepatic steatosis: Increased hepatic echogenicity with attenuation or reduced visualization of deeper structures.
• Cirrhotic change: Coarse hepatic echotexture, irregular contour, and altered hepatic architecture.
• Focal liver lesion: Focal abnormality differing in echogenicity or architecture from the surrounding hepatic parenchyma.
• Caudate lobe enlargement: Increased size of the CL, which may be seen in chronic liver disease.
• Hepatic venous abnormality: Altered caliber, course, patency, or Doppler flow involving the LHV.
• Portal venous abnormality: Altered caliber, intraluminal abnormality, thrombosis, or abnormal Doppler flow involving the PV.
• Ligamentum teres abnormality: Altered appearance or prominence of the LTH should be correlated with the surrounding anatomy.
• Venous ligament abnormality: Altered visualization or anatomical relationship of the VL.
• Portal hypertensive changes: Enlarged portal venous structures or collateral vessels may be present in the appropriate clinical setting.

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