McConnell’s sign is an echocardiographic finding characterized by akinesis or severe hypokinesis of the mid–right ventricular free wall with preserved or hyperdynamic apical contraction.
Traditionally, it is regarded as a highly specific sign of acute pulmonary embolism, reflecting acute right ventricular pressure overload and dysfunction.
Key points:
- Best identified on transthoracic echocardiography.
- Suggests acute right ventricular strain.
- Has high specificity but low sensitivity for acute pulmonary embolism.
- Its presence should prompt urgent evaluation for PE, but it is not pathognomonic.
A meta-analysis reported a sensitivity of only 22% but a specificity of 97% for diagnosing acute pulmonary embolism.
The proposed mechanisms include right ventricular free-wall ischemia from increased wall stress, altered RV geometry due to acute pressure overload, and tethering effects from a hyperdynamic left ventricular apex.
McConnell’s sign remains one of the most recognized echocardiographic clues to acute pulmonary embolism, but interpretation should always be integrated with the overall clinical picture.
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Two patients, one pediatric 👶and one adult 👩, with remarkably similar echo findings (seen on TTE & TEE).
LV myocardial hypertrophy and LV wall thickening are closely related, but they are not exactly the same.