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Ultrasound signs of a normal liver
Last reviewed: 06.07.2025
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The normal liver parenchyma appears as a homogeneous structure interrupted by the portal vein and its branches, which are visualized as tubular linear structures with echogenic walls. The thinner hepatic veins are anechoic. In the normal liver, the hepatic veins can be traced throughout their length to their confluence with the inferior vena cava. The hepatic veins dilate during the Valsalva maneuver (formed expiration with the mouth and nose closed). The inferior vena cava is visualized in the liver and may vary depending on the respiratory cycle. The aorta is seen as a pulsating structure posterior and medial to the liver.
The falciform ligament fissure is defined as a structure of increased echogenicity just to the right of the midline in the cross section.
In addition to the right and left lobes of the liver, it is necessary to recognize the caudate lobe, which is limited posteriorly by the inferior vena cava and separated anteriorly and superiorly from the left lobe by a hyperechoic line. Inferiorly, the caudate lobe is limited by the proximal part of the left portal vein. It is necessary to be able to identify the caudate lobe, since it can be mistaken for a tumor.
The gallbladder and right kidney should also be recognized. The gallbladder is visualized on longitudinal sections as an anechoic, pear-shaped formation.
The spine and pancreas need to be identified.
The echogenicity of a normal liver is intermediate between that of the pancreas (which is more echogenic) and that of the spleen (which is less echogenic).