A 54 year old female with history of severe liver cirrhosis presented with extensive ascites. Ultrasound was requested to assess fluid status and degree of ascites one day following paracentesis and multiple days of diuresis. While performing the ultrasound, I was unable to visualize the IVC from the Subxiphoid view despite having good acoustics due to the ascites. The IVC was not in sight nor was the liver. I had to move the probe nearly 18 inches laterally to the right and fanned medially where I found the small liver and the IVC coursing through it.
If you find yourself performing an US on a cirrhotic patient, anticipate that the anatomy may be a little different as the liver shrinks and the abdomen expands with ascites.
-Michael Douglas MS4