3 Blood Vessels: Aorta and Branches, Vena cava and Tributaries

Position the transducer for a slightly lower longitudinal scan (Fig. 3.22a),
then rotate it to a transverse scan. Identify the origin of the renal arteries,
scan down the aortic segment below that, and continue scanning to the level
of the bifurcation (Fig. 3.22b-d).
Fig. 3.22
Demonstrating the renal arteries and aortic bifurcation
a
b Transverse scan at the level of the
renal arteries ( ). Aorta ( ),
vena cava ( ).
c Transverse scan below the origin
of the renal arteries. Aorta ( ),
vena cava ( ).
Low longitudinal scan of the aorta.
Lines indicate the transverse scan
planes in b, c, and d.
d Transverse scan at the level of the
bifurcation. The iliac vessels ( )
are seen. Vena cava ( ).
Vena cava tributaries
You know the tributaries of the inferior vena cava that are visible with ultra-
sound: the hepatic veins, renal veins, and iliac veins. These vessels also have
typical ultrasound appearances (Fig. 3.23).
Demonstrating the vena cava tributaries
Place the transducer longitudinally over the upper part of the inferior vena
cava. Angle the scan through the upper portion of the liver, and identify the
vena cava at the site where it pierces the diaphragm (Fig. 3.24a). Now rotate
the transducer to a transverse plane and locate the site where the hepatic
veins enter the vena cava below the diaphragm (Fig. 3.24b). Move the scan
down the vena cava and observe the course of the hepatic veins through the
periphery of the liver, then the distal segment of the vena cava itself
(Fig. 3.24c,d).
Fig. 3.23 Tributaries of the inferior vena
cava viewed from the front, from the
side, and in cross section. Vh = hepatic
vein, Vr = renal veins, Vic = common iliac
veins.. Vh = hepatic vein, Vr = renal veins,
Vic = common iliac veins.