Abstract
Background
McConnell's sign (right ventricular [RV] free wall hypokinesis with apical sparing
on echocardiography) is often described as very specific for the diagnosis of pulmonary
embolism (PE). We present the case of a patient who, despite manifesting a classic
McConnell's sign, was not found to have a PE.
Case Report
A 58-year-old woman presented to the emergency department with a cough, dyspnea, and
leg swelling. A bedside focused cardiac ultrasound revealed hypokinesis of the RV
free wall, with apical sparing, in the apical four-chamber view. A computed tomography
angiogram for PE was negative. Ultrasounds of both lower extremities were negative
for deep venous thrombosis, and a D-dimer was only marginally elevated. The patient
was ultimately diagnosed with pulmonary hypertension due to chronic obstructive pulmonary
disease and systemic lupus erythematosus.
Why Should an Emergency Physician Be Aware of This?
Emergency physicians should be aware that McConnell's sign is not completely specific
for acute right heart strain from PE.
Keywords
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Article Info
Publication History
Published online: May 16, 2015
Accepted:
December 21,
2014
Received in revised form:
November 6,
2014
Received:
September 13,
2014
Footnotes
Streaming video: Four brief real-time video clips that accompany this article are available in streaming video at www.journals.elsevierhealth.com/periodicals/jem. Click on Video Clips 1, 2, 3, and 4.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
