For the Love of Livers; Dont underestimate the power of a deep breath in decubitus

When scanning a liver, sometimes no matter how high on the ribs you are, or other techniques you utilize, it seems like it is forever outside your reach looming elusively somewhere in the chest and it’s a battle between artifact from air in the lung and bowel botching up your beam’s ability. Sometimes the available window within which you can image a liver is limted/reduced by an exorbitant amount of air in the bowels from an ileus, belly virus, constipation that causes abnormal distention of bowel loops, or a herniated diaphragm that allows the bowels to cross their native line and yuck up your image. No fear, these techniques done in tandem will aid you in locating that slippery little liver.

Roll the patient up in left lateral decubitus, this will let the bowel fall off
the liver margins, give it a minute, its not instant. Have them take in a deep breath to push the bowels out further from your scan window. If they are unable to hold their breath very long, or they have an oxygen deficit, you obviously dont want to send them into a hyperventilating fit, so try this; with your probe most likely near the armpit at about 10:00 for sag, and 9:00 for transverse (to get between the ribs) when they take a deep breath in SLOWLY scan through your window, and hit freeze–tell the patient to breath (important). Now you can CINE loop through the frames to select the images you like as long as you went slowly enough to avoid motion artifact.