McConnell's sign: Echocardiography in the management of acute pulmonary embolism

Abstract

Management of acute pulmonary embolism depends immensely on rapid diagnosis and early intervention. Transthoracic echocardiography has gained favorability in scenarios where diagnostic computed tomography angiography is not feasible. McConnell's sign, an echocardiographic finding of segmental right ventricular wall‐motion abnormality with apical sparing, is highly specific and may guide therapeutic intervention. We present the case of a 59‐year‐old man who was found to have acute pulmonary embolism with obstructive shock, managed successfully with thrombolytic therapy after identification of McConnell's sign. We review current literature and develop a framework for the integration of echocardiography into the multimodal approach to management.

Notching into a Diagnosis—Incorporating Doppler Interrogation into Point-of-Care Ultrasonography to Diagnose a Submassive Pulmonary Embolism

“… 1 Other findings on two-dimensional echocardiography include the McConnel’s sign, as seen in our case, which is often an early and specific sign suggestive of PE, although this is present in only 12% to 20% of cases. 2 , 3 It should be noted that it is merely an appearance of having “spared” the apex, when most likely this relates to tethering of the apex to an otherwise normal or hyperdynamic left ventricle, via transmitted septal forces. 4 Additionally, absence or presence of pericardial effusion and a depressed RV function are both neither sensitive nor specific.…”

Comparison of echocardiographic pulmonary flow Doppler markers in patients with massive or submassive acute pulmonary embolism and control group: A cross‐sectional study

“…In addition, MC sign was specified as akinesia of the mid free wall with apical sparing. 15 , 16 , 17 …”

“…The ESN pattern was represented as a sharp notch after a narrow spike in the RVOT Doppler envelope. In addition, MC sign was specified as akinesia of the mid free wall with apical sparing 15–17 …”

Saddle Pulmonary Embolus Treated With Bilateral Emergent Aspiration Pulmonary Thrombectomy

“…A new right ventricular (RV) wall-motion dyskinesis with apical sparing (positive Mc-Connell sign) was noted on bedside echocardiogram. 2 Bilateral lower extremity ultrasound showed an acute DVT in the right posterior tibial and peroneal veins, and a chronic DVT in the left popliteal, posterior tibial and peroneal veins. In the ED, he was placed on a heparin drip and underwent an emergent catheter directed aspiration pulmonary thrombectomy as his recent surgery precluded the administration of systemic thrombolysis.…”