There is no doubt that over the past 10 years the average size of our patients has increased noticeably. It is well recognized that body habitus plays a role in echo image quality, with both unusually small and large patients potentially being difficult to image. There is however considerable variability between individuals and it is near impossible to predict image quality just by “sizing” the patient up.
The following clips are 2D images of the aortic valve taken from the PSAX view. Both patients are male and 5ft 11in (180cm) tall. Patient A however weighs 165lbs (75kg) and Patient B weighs 330lbs (150kg). There is not a lot of difference in image quality between the 2 patients. and in fact, when you look closely, the much larger patient B has some exceptional detail in his images!
So, what is the moral of the story??
Every story has to have a point… and the point today is that you can’t judge a patients images by their size. It may be a physical strain to image some patients because of their size, but it does not automatically mean we are going to obtain poor images. I have heard some Drs suggest that a patient should automatically go on to have an MRI (without even trying an echo first) just because of body habitus, pre-judging the patient as having poor images without even looking. Often these are for clinical questions that would easily be sorted out with a cheaper and more accessible echocardiogram. It is ALWAYS worth a look with the echo first and additional imaging modalities can be arranged later if needed.
And sonographers… don’t pre-determine your image quality before you even start the test. Optimize the image as best you can and more often than not you will obtain diagnostic data. If you are convinced that you are going to obtain poor images, then you probably will…. Have a positive outlook and you might even image some echo gold like this view of the coronary arteries (yes, it is in the 330lbs/150kg man!!!).
Special thanks to Dr Justin Morze, Hearts 1st – Brisbane for the fantastic images….
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