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Subxiphoid IVC view: beyond estimation of right atrial pressure

We routinely use inferior vena cava view to get an idea of the right atrial pressure by evaluating the vessel’s maximal diameter and collapsibility. In certain cases, this view can provide additional information that calls for a more detailed evaluation. Of course, only if you pay attention to the surroundings. Here are a few examples.

Case 1: This subcostal view demonstrates an anechoic area between the liver and the heart, which corresponds to pericardial effusion, prompting you to evaluate other cardiac windows.

Case 2: In this image, you can see a mobile echogenic structure in the right atrium (arrow) possibly adherent to tricuspid valve. Further evaluation revealed tricuspid valve endocarditis.

Case 3: In this color Doppler image, note how the blood is flowing from the right atrium into the hepatic vein. Normally, hepatic vein should appear blue as the blood flows away from the transducer (= towards the heart). In this case, you see a red jet as well as mixture of colors indicating high velocity flow away from the heart during each beat, indicative of tricuspid regurgitation. This patient had chronic severe tricuspid regurgitation; also note that the IVC is plethoric.

Case 4: This image demonstrates a snake-like hyperechoic mobile lesion within the IVC, which eventually was diagnosed as a tumor thrombus from renal cell carcinoma (RCC). As discussed previously, RCCs are notorious for Venous migration and tumor thrombus formation.

Case 5: The anechoic area posterior to IVC in this image corresponds to right pleural effusion. We have previously discussed this scenario and anatomic correlation.

Case 6: This IVC view here shows something floating within the right atrium, which turns out to be a myxoma.


  1. Abhilash, Thanks for the insight you have given the non RAD savy nephrologists . Hope this is mandatory training for all fellows .

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