How to perform an ultrasound of the liver

In this video, you'll learn how to perform your very first liver ultrasound with Dr Nikolaus Mayr.

Dr Mayr will show you how to perform standard ultrasound sections of the liver using the best sound windows. He will take you step-by-step through the process of positioning your patient correctly for smoother imaging, right through to locating various components of the liver. While you're at it, check out this video which explains liver topography and landmarks.

Want to perform your own kidney ultrasounds? Take our Abdominal Ultrasound Essentials course and you'll become a pro in no time. Your instructor, Dr Nikolaus Mayr–the Chief Resident of Radiology at the Hospital of the Brothers of St. John of God in Salzburg–will guide you through all the ins and outs of abdominal sonography. Boost your medical career with Medmastery today!

[00:00:00] I'm going to show you the standard ultrasound evaluation of the liver. For that, I will ask the patient if he has eaten. Patient: I ate two hours ago. I will use some ultrasound gel on the right epigastrium and use the curved array sonographical probe. The standard abdominal pre-settings of your sonographical machine will be sufficient. First of all, I go into the

[00:00:30] median of the body, into the right epigastrium and I'll tell the patient to take a deep breath and hold it. Here, we can see that I'm going to a cross-section of the left liver lobe. When I've done that, I will ask the patient to exhale then inhale again and hold it and go to the right epigastrium

[00:01:00] and can evaluate the right liver lobe. Sometimes, it's not very easy to fill in all of the blank parts of the right liver lobe because of the air that is in the colon and the patient has eaten two hours ago. So, you can also put the right arm over your head. Take a deep breath again and here, you can see the picture getting a little bit better but still it's not

[00:01:30] optimal. Can you turn around to the left side a little bit? Yes, that's good. Take a deep breath again. Now, we can see the right liver lobe a little bit better. When I've done that I go into the standard cross-sections of the center of the liver. The most cranial of them representing the liver vein star, as you can see here,

[00:02:00] joining in the inferior vena cava, as you can see, which would be the structure, here. Exhale again. Take a deep breath and hold it. The next cross-section is the jumping stag sign, as you can see here. You can see, like the horns and the head of the stag, then you can see the body.

[00:02:30] The legs going away, which is the portal vein branching in the center of the liver. Exhale again. Take a deep breath again. The next structure you can evaluate, here, is this echogenic line that is between the right and left liver lobe. This is the interlobar ligament, which ends in teres hepatis ligament. Exhale again. Take a deep breath again. When you follow the tail

[00:03:00] of the jumping stag sign, as you can see here, you will find the gallbladder, which is here. Exhale again. When I’ve done that, I go into a long section through the body to evaluate the left liver lobe in a long section. Take a deep breath again and hold it. You can see the quite filled stomach, on the right side of the picture. You can see the entrance into the stomach

[00:03:30] and you see the diaphragm has a small echogenic line between the heart and the liver. Exhale again. Take a deep breath again. When I push the probe more to the right side, I come more to the liver center and you see two different structures. You see the echogenic circling around the portal vein, which is the tissue around the portal vein branch. And you see

[00:04:00] the structure that has no echogenic structure around it, which is a liver vein. So, this is the difference between the portal vein and the liver vein, is that there is no connective tissue around the vein. Exhale again. Take a deep breath again. When I move farther over, come to the right liver lobe, you see the portal vein of the right liver, right portal vein, and you see the

[00:04:30] gallbladder again. Then I move gradually down to the end of the liver. Here comes the right kidney. So, exhale again and lie back. When there's too much air in the colon, so you cannot see the right liver lobe from the front, there's always a possibility that you go into a transcostal view of the right liver lobe, as you can see here. You can find a sound window where you can just tilt

[00:05:00] the probe at the same position and try to evaluate the right liver lobe through the costal view, which can help at the center sometimes, when you don't see the portal vein.