Kira hart

PATIENT: Kira hart

HISTORY: exercise intolerance, one episode of collapse, obese+++, normal ACTH stimulation test, elevated AP (1150)

Abdominal U/S

SUMMARY:

The hyperechogenicity of the liver is likely to reflect fatty infiltration in an obese patient, and there is a large quantity of fat deposition throughout the abdomen.

In conjunction with the findings of the cardiac ultrasound (fat causing cardiac displacement) there is evidence here of significant fat infiltraion of the organs and cavities, which would also be a likely contributary cause for the upper respiratory noise and rapid respiratory rate of the patient, and therefore be an explanation for the exercise intolerance and episode of collapse.  Significant steady weight loss is advised and repeat ultrasound could be undertaken once this is acheived to reassess the abdominal organs and cavities.

LIVER: Normal: moderate to marked diffuse increase in echogenicity, considered normal for the obese nature of the patient

BILIARY TRACT: Normal

SPLEEN: Normal

LEFT KIDNEY: Normal

RIGHT KIDNEY: Normal

LEFT ADRENAL: Normal 4mm

RIGHT ADRENAL: Normal 5mm

URINARY BLADDER: Normal

ILIOSACRAL LYMPH NODES: Normal

VISCERAL LYMPH NODES: Normal

STOMACH: Normal

SMALL INTESTINES: Normal

LARGE INTESTINES: Normal

PANCREAS: Normal

GENITAL TRACT: Not applicable

OTHER: large sternal fat pad and large quantity of intra-abdominal fat

Echocardiography

SUMMARY

Normal cardiac structure and function, however large quantity of intra-thoracic fat causing cardiac displacement from the chest wall bilaterally.

B-MODE

Comments:  The heart is displaced from the chest wall by intra-thoracic fat.  cardiac chambers, valves and outflow tracts appear normal and systolic function is good.  Heart rate is approximately 100bpm, sinus rhythm

LV Index of Sphericity (normal >1.65) 1.8

LA:Aortic ratio (RPS SA, normal <1.6) 1.6

LA:Ao ratio (RPS LA, normal <2.5) 2.1

M-MODE

FS  40%,  EPSS 0.2 cm.

WALL THICKNESS AND CHAMBER DIMENSIONS COMMENTS: none

COLOUR DOPPLER

No abnormal jets or turbulent flow demonstrated

SPECTRAL DOPPLER

MITRAL INFLOW: Mitral Regurgitation? no

AORTIC OUTFLOW: Max Velocity  1m/s.  Aortic Regurgitation? no

TRICUSPID INFLOW: Tricuspid Regurgitation? no

PULMONIC OUTFLOW Max Velocity 0.9 m/s.  Pulmonic Regurgitation? no

U/S Guided Samples: Results

Not Applicable.

ECG
Not Applicable.

Endoscopy
Not Applicable.

Other

Not Applicable

SUMMARY

LIVER

Normal

BILIARY TRACT

Normal

SPLEEN

Normal

LEFT KIDNEY

Normal

RIGHT KIDNEY

Normal

LEFT ADRENAL

Normal

RIGHT ADRENAL

Not visualised

URINARY BLADDER

Normal

ILIOSACRAL LYMPH NODES

Normal

VISCERAL LYMPH NODES

Normal

STOMACH

Normal

SMALL INTESTINES

Normal

LARGE INTESTINES

Normal

PANCREAS

Normal

GENITAL TRACT

Not applicable

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