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- Under the ribcage
- AKA Subxiphoid view
- View from subcostal window should be considered a standard view and should be performed on all patients.
- it is an ideal view for anyone with COPD, emphysema, heavy smokers, etc.
- anyone whose parasternal and apical views are severely limited or suboptimal due to lung interference would benefit from these views.
- It avoids lung noise by using the liver as an acoustic window.
INTERFERENCE ON SUBCOSTAL VIEWS
- Bowel gas
- obese patient
- Patient's with very dense liver echogenicity from conditions such as cirrhosis or fatty infilatrative disease
VIEWS OBTAINED FROM SUBCOSTAL APPROACH
- Subcostal 4-chamber
- Subcostal short axis- the 3 levels are the same as the parasternal short axis
- IVC/Hepatic vein view
PATIENT POSITIONING FOR SUBCOSTAL VIEW
- The patient should be supine, knees bnt, flat on the bed.
- The patient is usually asked to take a deep breath and maintain it as long as possible
- - This decreases intrathoracic pressure and causes the diaphragm to expand, pushing abdominal organs down while expanding the rib cage and pulling the heart down. This brings the heart closer to the transducer.
TRANSDUCER POSITION FOR SUBCOSTAL
- The transducer is placed just below the xiphoid process and slightly to the right of the midline, away from the stomach on a softer portion of the abdomen
- Aim the transducer towards the patient's left shoulder
- The transducer index should be towards the patient's left should or 3 o'clock.
- Hold hand above the transducer, rather like a pencil. This enables the transducer to angle under the rib and prevents the hand from interfering with the scan.
- The sound beam should transect the body into ventral and dorsal halves
- This view is comparable to the apical 4-chamber view
- The right heart is closest to the transducer at the top of the imaging sector
- - RA is to the left of the screen
- - RV is to the right of the screen
RV IN SUBCOSTAL 4-CHAMBER
- One of the best views for RV to e evaluated for size and function, and for making RV free wall measurements.
- Because RV is perpendicular to the sound beam, artifacts like reverberation can be eliminated
OTHER EVALUATIONS FROM SUBCOSTAL 4-CHAMBER
- The area around the heart should also be evaluated for the presence of pericaridal fluid, tumors, and masses.
- The IAS is also best evaluated in this view
DOPPLER IN SUBCOSTAL 4-CHAMBER