PATIENT: Kira hart
HISTORY: exercise intolerance, one episode of collapse, obese+++, normal ACTH stimulation test, elevated AP (1150)
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
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
SMALL INTESTINES: Normal
LARGE INTESTINES: Normal
GENITAL TRACT: Not applicable
OTHER: large sternal fat pad and large quantity of intra-abdominal fat
Normal cardiac structure and function, however large quantity of intra-thoracic fat causing cardiac displacement from the chest wall bilaterally.
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
FS 40%, EPSS 0.2 cm.
WALL THICKNESS AND CHAMBER DIMENSIONS COMMENTS: none
No abnormal jets or turbulent flow demonstrated
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