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The subcostal bicaval view

We are familiar with the subcostal 4 chamber and inferior vena cava (IVC) views. There is also something called subcostal bicaval view, where you can visualize both IVC and the superior vena cava (SVC). This view is helpful to evaluate the tip of dialysis catheter, pacemaker leads, flow pattern in SVC etc. However, its not always easy to get this view, especially in patients with central adiposity. To image the SVC, first optimize the image of IVC long axis, increase the depth, and angle the transducer toward the head, which brings SVC into view. The SVC will be at the bottom of the sector at ~5 to 6 o’clock, seen entering into the right atrium (RA). Below are some examples.

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