Subcostal Windows
A selection of echo clips of the heart in the subcostal windows are shown below. Can you describe what you see? Is there any pathology present? Or is the clip normal?
Clip 1
The clip above shows a subcostal view of the IVC in a spontaneously breathing patient. Hiis BP is 95/56 mmHg currently. What do the findings suggest?
The IVC is collapsed, and the diameter is <1 cm here. This is highly predictive that the patient will be fluid responsive and benefit from a fluid bolus. Static measurements of the IVC are not useful to determine fluid responsiveness, except at extremes. What other echo measures of fluid responsiveness are there?
Clip 2
This patient is spontaneously breathing. What do you think about the IVC and respiratory variability?
The IVC looks dilated and plethoric. It's diameter is greater than 2.0cm. There is minimal respiratory variability. Further echo views should be obtained to determine if this is a significant finding.
Clip 3
Moving from clip 2, the subcostal 4 chamber view is obtained in the same pateint. What does it indicate?
The subcostal 4 chamber view shows the presence of a large pericardial effusion. There is RV diastolic collapse present, and the heart is hyperdynamic. These findings are indicative of pericardial tamponade. What would you do next?
