| Vessel |
Image Plane |
Technique |
| LHV |
Transverse / Longitudinal |
- Locate the left lobe of the liver.
- Identify the inferior vena cava and angle steeply towards the diaphragm.
- The LHV and MHV should be seen as they drain into the IVC.
|
| LPV |
Transverse, coronal, intercostals, decubitus |
- Locate horizontal segment of PLV, adjust transducer to obtain steepest angle for Doppler (parallel to the vessel), and zoom in on the LPV
|
| LHA |
Transverse |
- Usually found posterior to horizontal segment of LPV.
- After interrogating the PLV, look for LHA with color Doppler (expand color box to cover the LPV and adjacent liver tissue).
- Place PW cursor/ sample volume in area of LHA (suspend respiration); watch for "flashing" of signal as it comes in and out of view with respiration.
- Look for LHA on deep inspiration.
- If you can't get the signal in the periphery of the liver, move to another location closer to the main portal vein.
|
| Common HA |
Longitudinal - porta hepatis |
Use same technique as described for LHA
- Transplant recipient patients: usually only able to Doppler HA at the porta hepatis
- Include extra-and intrahepatic segment of HA
- Difficult to image site of anastomosis
|
| MPV |
Longitudinal - porta hepatis |
- If shunt is present, anastomosis site easier to identify (more prone to thrombosis); be sure to investigate the MPV proximal, within, and distal to anastomosis.
|
| IVC |
Longitudinal, coronal - slightly to right of midline; suspend breath. Angle transducer in cephalad to caudal sweep to record flow |
- May be difficult to obtain good angle because of horizontal location on transverse plane.
- If shunt is present, evaluate site of anastomosis carefully (proximal, within, and distal)
- Look carefully for presence of internal echoes that represents thrombosis.
- If you suspect thrombus is present, and the Doppler signal is very "choppy" with high velocity and little phasicity, the likelihood of thrombus is good.
- Be sure to follow the IVC all the way into the right atrium of the heart.
|
| SV |
Transverse |
- Evaluate SV from the splenic hilum to the portal-splenic confluence
|
| RHA |
Transverse, Anterior to right posterior portal branch. |
- Use same techniques as mentioned to Doppler the RPV and RHA.
- If you are unable to locate the RHA in the periphery of the liver, move closer to the trunk of the adjacent PV.
- If you can't find the RHA at the right posterior portal branch, try looking for it at the level of the right anterior PV branch.
|
| RPV |
Anterior, intercostals approach; one rib space away from window for porta hepatis |
- To locate right posterior branch of RPV, begin with the MPV at the porta hepatis
- Follow the MPV into the liver until you see the RPV.
- The posterior branch extends posteriorly into the right lobe. It is easier to obtain a good Doppler angle if you use a more anterior, intercostals approach.
- Make small movements with the probe to get into the right posterior portal branch.
|
| RHV |
Transverse, subcostal |
- Place the probe just below the level of the xyphoid with a steep angulation toward the diaphragm.
- Locate the IVC; the RHV will be seen in the right lobe of the liver in a horizontal plane as it empties into the IVC.
|
| MHV |
Transverse, subcostal |
- Place the probe just below the level of the xyphoid with a steep angulation toward the diaphragm.
- Locate the IVC; the MHV will be seen in a vertical plane as it separates the right lobe from the left lobe of the liver as it empties into the IVC.
|
댓글