2
EASy MAPSubcostal IVC
View 2 · probe position B · venous return
Machine setup
- Sector (phased-array / cardiac) probe — the same probe for all six views.
- Adult Cardiac preset, B-mode.
- Marker indicator on the upper right of the screen (cardiology convention).
- Depth 21 cm.
- Frequency at the probe's lowest setting (typically 2 MHz).
- TGC on; increase far gain to fill in the far field.
Acquire
- Remove the probe entirely from the subcostal area, then rotate the marker cephalad (12 o'clock).
- Replace it at the same location used for the cardiac view, in the new orientation.
- Angle the beam slightly toward the patient's left (tail toward the patient's right) to find the aorta.
- The IVC sits within the liver, just to the patient's right of the aorta.
- Watch the vessel through the respiratory cycle and call it qualitatively — flat, normal size with respiratory variation, or plethoric. EASy does not measure the IVC.
- Record a 4 s clip of the IVC, then a 4 s clip of the aorta.
Pitfalls
- Aorta and IVC look alike side by side — identify both, or you will read the aorta as a non-collapsing IVC.
- A flat IVC is not automatically an empty patient — external compression flattens it too. Raised intra-abdominal pressure (abdominal compartment syndrome, gravid uterus, laparoscopic insufflation) is obstructive physiology wearing a hypovolemic mask.
- The hepatic vein draining into the IVC is an alternative landmark, but positive aortic identification works in essentially all patients.
- Interpret the IVC with caution when the patient is not supine.
- Obstructive causes of shock change IVC size and variation regardless of intravascular volume.
Why lift the probe off
Coming off the skin entirely before rotating prevents mistaking the right hepatic vein for the IVC. Either an underhand or overhand grip works for this view.
Read it — three states, no numbers
| What you see | What it means |
|---|---|
| Flat | Poor venous return — or external compression |
| Normal size, varies with respiration | Neither flat nor plethoric |
| Plethoric | Poor forward flow |
Optional add-ons from here
- Rock the tail inferiorly from the aorta → aortic valve.
- Rock inferiorly and tilt toward the patient's right, rotating toward the left shoulder → midpapillary short axis.
- Rock the tail cephalad from the aorta → gastric antrum, if fasting status matters.
What this view adds
Venous return and filling pressure. Read with the heart, the IVC says whether the picture is under-filled or congested — and how much fluid the patient will tolerate.