The hepatic venous system is best visualized with the patient supine or turned slightly to the left (at end-expiration if possible), especially if Doppler waveforms are to be obtained. Because of the superior location of the hepatic veins, deep inspiration may be necessary to improve visualization when using color Doppler. The left hepatic vein can best be visualized with the transducer in a sub-xiphoid location in a longitudinal plane. Transverse subcostal or slightly oblique images obtained more laterally or through an intercostal space will be useful when visualizing the middle and right hepatic veins. When visualizing the hepatic venous system, an effort should be made to show the communication of the hepatic veins with the inferior vena cava, especially in patients in whom the diagnosis of Budd-Chiari Syndrome is suspected.
