Echocardiography Imaging Windows - The Subcostal View

A Subcostal view is obtained by placing the probe 3-4 centimeters under the xiphoid. Echocardiographer should ask the patient to lie on his back and bend his knees, this relaxes the abdominal musculature and a better quality of images are obtained. 
This view is utilized in the immobile patients, patients suffering from COPD or in the patients on ventilatory support where parasternal view is not possible. 

The Four Chamber Plane of Subcostal view - In the four chamber plane the inferior surface of the right ventricle rests on the diaphragm. The echo beam reaches the heart through corner of the liver. The echo beam in this medium is perpendicular to the heart, so interatrial and interventricular septum are easily visualized. There are no drop outs of echo signals in this view as it happens in Apical 4 chamber view, that is why you can easily diagnose and evaluate interatrial and interventricular shunts. 

You can even differentiate among the following interatrial defects. 

• Defect in the area of Fossa Ovalis (Secundum Type)
• Lower defect which is extending upto Mitral Annulus ( Primum)
• Sinus Venosus defect which is located high in the roof of an Atria. 

The subcostal four chamber view allows to evaluate LV and RV functions as well as valve regurgitations.

Subcostal Inferior Venacava View

You can confirm the morphology of right atrium by tilting the plane inferiorly, this shows the inferior venacava entering into the right atrium. The inferior venacava is lateral and anterior to decending aorta. These two vessels can be distinguished by seeing the pulsation of aorta or by asking the subject to inhale which sucks the blood to the chest and as a result IVC collapses. This view also allows you to diagnose pericardial effusion because you can easily assess the degree of separation of heart from the pericardium. 

Subcostal Short Axis View - 

The short axis subcostal view is same as PSAX( Parasternal short axis view). One can obtain a short axis of the left ventricle. This view allows you to estimate function  of left ventricle and visualize aortic, pulmonic as well as  tricuspid valves. 

.