Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Technique ++ Direct the transducer indicator to the patient’s right (in abdominal or general preset). Note that the E-FAST exam is traditionally performed with abdominal preset settings, but the subxiphoid view is often performed with cardiac preset settings as part of a full focused cardiac ultrasound exam. When this is the case, the marker dot is typically on the opposite side of the screen and the indicator is oriented to the patient’s left. With the transducer indicator pointing to the patient’s right, the transducer is directed under the xiphoid process toward the left shoulder in a horizontal or near-coronal plane (Fig. 24.8). Pivot, sweep, and tilt the transducer as necessary to view all four cardiac chambers and pericardium. Identify the liver (if in view), heart, four cardiac chambers, and surrounding pericardium (Fig. 24.9). ++ FIGURE 24.8 Subxiphoid View. The transducer is directed under the xiphoid process toward the left shoulder in a horizontal plane. (Photo contributor: Lawrence B. Stack, MD.) Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ FIGURE 24.9 Subxiphoid View. The heart, four cardiac chambers, and surrounding pericardium are seen in this view. (Illustration contributor: Robinson M. Ferre, MD; ultrasound contributor: Jeremy S. Boyd, MD.) Graphic Jump LocationView Full Size||Download Slide (.ppt) Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ Vedio Graphic Jump Location Video 24-01: Subxiphoid View Play Video +++ Abnormal Findings ++ Hemopericardium (pericardial effusion): Pericardial fluid will appear as an anechoic (black) region noted between the pericardium and the right ventricle. As more fluid collects, the fluid will be seen completely surrounding all four chambers of the heart. Occasionally, internal echoes representing fibrin, clot, or cardiac tissue may be present within the pericardial space (Fig. 24.10). Asystole: No cardiac activity present. Hyperdynamic cardiac activity: Extensive cardiac contraction with near-total or complete collapse of the cardiac chambers, often associated with tachycardia and hypovolemia. ++ FIGURE 24.10 Hemopericardium. Pericardial fluid appears as an anechoic (black) region noted between the pericardium and the right ventricle. Hemopericardium is denoted by the asterisks in the diagram. (Ultrasound contributor: Jim Fiechtl, MD; illustration contributor: Robinson M. Ferre, MD.) Graphic Jump LocationView Full Size||Download Slide (.ppt) Graphic Jump LocationView Full Size||Download Slide (.ppt) ++ Vedio Graphic Jump Location Video 24-02: Hemopericardium Play Video +++ Pearls ++ When the view is obscured by gas, slide the transducer slightly to the patient’s right subcostal region, and use the right lobe of the liver as the sonographic window. If unable to view the heart in the true subxiphoid or subcostal window, move to a parasternal long-axis view (see “Focused Cardiac Ultrasound” later in this chapter). A frequent mistake in imaging is to direct the transducer posterior toward ... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth