Transverse-Oblique View of the Left Liver Through the Longitudinal Section of the Left Hepatic Vein on the Subxiphoid

Transverse-Oblique View of the Left Liver Through the Longitudinal Section of the Left Hepatic Vein on Subxiphoid

Transverse-oblique left liver section • Left 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 obliquely in the subxiphoid region. Direct the probe to obtain a transverse-oblique section of the left lobe of the liver through the longitudinally visualized left hepatic vein. Adjust the probe angle and depth to clearly demonstrate the left hepatic lobe, left hepatic vein, and relevant adjacent anatomical structures.

Key scanning point: Begin from the subxiphoid region with the probe oriented in a transverse-oblique direction. Identify the left hepatic vein as the principal anatomical landmark and adjust the probe position and angle to obtain a clear transverse-oblique view of the left liver through the longitudinal course of the left hepatic vein.

Ultrasound Image

Figure 1.1 Transverse-oblique view of the left liver through the longitudinal section of the left hepatic vein 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, left liver, left hepatic vein, and labeled anatomical landmarks.

Section Structure

The principal structures demonstrated in this plane are the left hepatic lobe (LL), the left hepatic vein (LHV), and the inferior vena cava (IVC). The left hepatic vein serves as the principal vascular landmark for confirming the correct scanning orientation. The IVC is demonstrated at the inferior aspect of the scanning field, with the left hepatic lobe forming the main hepatic component of the image.

Structures to identify

• Left hepatic lobe (LL)
• Left hepatic vein (LHV)
• Inferior vena cava (IVC)
• Hepatic parenchyma
• Diaphragmatic surface of the liver
• Adjacent upper abdominal structures

Abbreviations Used in the Figure

Abbreviation	Full form	Identification
LL	Left lobe	Left hepatic lobe demonstrated in the scanning field.
LHV	Left hepatic vein	Hepatic vein coursing through the left hepatic lobe toward the IVC.
IVC	Inferior vena cava	Major venous structure demonstrated inferior/posterior to the liver.

Measuring Method and Normal

When clinically indicated, evaluate the left hepatic vein (LHV) along its visualized longitudinal course. Assess its caliber, continuity, and relationship to the inferior vena cava (IVC). Measurements should be obtained only when required by the clinical examination or specific diagnostic indication.

Measurement	Caliper method	Reference / interpretation
Left hepatic vein (LHV)	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 Doppler assessment is performed.

Measurement note: Keep the LHV clearly visualized and assess its continuity toward the IVC. Avoid including surrounding hepatic parenchyma or adjacent vessels in the measurement.

The Clinical Application Value

This plane provides a useful transverse-oblique view of the left liver through the longitudinal section of the left hepatic vein (LHV). It permits assessment of the left hepatic lobe (LL), left hepatic vein (LHV), and inferior vena cava (IVC) in a standardized subxiphoid orientation.

• Demonstration of the left hepatic lobe (LL).
• Identification of the left hepatic vein (LHV).
• Demonstration of the IVC as an important vascular landmark.
• Assessment of the continuity and caliber of the LHV when indicated.
• Assessment of the left hepatic parenchyma and hepatic contour.
• Recognition of focal abnormalities within the left hepatic lobe.

Quick Scanning Checklist

1	Fast the patient for 8–12 hours when appropriate.
2	Position the patient supine.
3	Place the probe in the subxiphoid region.
4	Angle the probe to obtain the transverse-oblique view of the left liver.
5	Identify the LL as the main hepatic structure.
6	Identify the LHV in its longitudinal course.
7	Identify the IVC as the major vascular landmark.
8	Assess the left hepatic lobe, LHV, and IVC for abnormal findings.

Diagnostic Pathology

The transverse-oblique subxiphoid view through the left hepatic vein (LHV) provides a useful assessment of the left hepatic lobe (LL), LHV, and inferior vena cava (IVC). Evaluate the hepatic parenchyma, liver contour, venous structures, and relationship of the LHV to the IVC for abnormal findings.

Key Sonographic Findings

• Left hepatic lobe enlargement: Increased size or altered morphology of the left hepatic lobe.
• Hepatic steatosis: Increased echogenicity of the hepatic parenchyma with reduced visualization of deeper structures.
• Cirrhotic liver: Coarse hepatic echotexture and irregular or nodular liver contour.
• Focal liver lesion: Focal alteration in echogenicity or architecture within the left hepatic lobe.
• Left hepatic vein abnormality: Altered caliber, abnormal course, narrowing, or nonvisualization of the LHV.
• Hepatic venous thrombosis: Intraluminal material with partial or complete loss of normal venous flow, when demonstrated.
• IVC abnormality: Abnormal caliber, narrowing, intraluminal material, or altered appearance of the IVC.
• Venous congestion: Enlargement of the LHV or IVC with associated venous flow abnormalities when present.

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.