This is a commonly heard term in echocardiography. Foreshortening occurs when the ultrasound beam does not cut through the true apex of the left ventricle but transects above and anterior of the true apex. It leads to a geometric distortion of the image of the left ventricle, making the apex look “rounded” instead of the normal “bullet” shape. As a result, the long axis of the left ventricle appears shorter and the false apex is thicker and apparently hyper-contractile resulting in an overestimation of both global and regional LV function and an underestimation of LV volume and length (See figures below). In addition, apical thrombus or infarction can be missed in this view.

How to correct: Foreshortening can be corrected by moving the probe more towards apex (= 1 intercostal space lower) and laterally.

Below is an example where an apical thrombus could have been missed because of not properly visualizing the true apex. Shared by Ashwag from Riyadh. From nephrology standpoint, this is more important in the cardiorenal clinic where we see patients with ischemic cardiomyopathy with low EF who are at high risk for clot formation.

Here’s another instance illustrating the oversight of an apical aneurysm on a foreshortened view. The right panel depicts the ultrasound beam (triangle) starting from the cardiac apex, revealing the aneurysm. Image courtesy: Diagnostics 2023, 13(11), 1848