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Echocardiographic Assessment of Pulmonary Embolism - McConnell’s Sign

Sofia Nikolova, Georgi Georgiev


Introduction: Pulmonary embolism (PE) is a complication of deep vein thrombosis, presenting with various clinical features. While the majority of cases remain unexpressed, some patients manifest with symptoms from dyspnea and tachypnea to acute cor pulmonale. Accurate diagnosis in the intensive care unit (ICU) or emergency department (ED) is crucial and requires various examinations, including bedside echocardiography.

Materials and Methods: This research included 34 systematic reviews and clinical cases acquired from PubMed and Science Direct, using the keywords PE, echocardiography, and McConnell’s sign.

Results: Pulmonary embolism is a condition that could remain unexpressed or result in a sudden death, depending on the size of the embolus entering the pulmonary vasculature. Up to 60% of cases of PE are asymptomatic and resolve on their own; however in cases with major vessel occlusion the patient faces life-threatening conditions such as severe hypoxemia or acute cor pulmonale. These cases are linked to high mortality rates, requiring early detection and specific management. The diagnostic process includes routine tests, such as chest radiography. However, bedside echocardiography allows fast and accurate diagnosis based on a distinct set of criteria.

Echocardiographic features of PE include severely dilated right ventricle (RV) with decreased systolic function, septal flattening, with normal movement and size of the left ventricle. McConnell’s sign is pathognomonic for PE. It is a type of an RV dysfunction consisting of akinesia of the mid-free wall but normal motion of the apex. The aim of this review is to analyze the clinical significance of McConnell’s sign in diagnosing acute pulmonary embolism.

Conclusions: Acute PE is a life-threatening condition, requiring urgent and accurate diagnosis for proper patient management. McConnell’s sign is the most distinct echocardiographic finding described in patients with acute PE. It may be useful in cases of massive pulmonary embolism in which a rapid presumptive diagnosis is required in ICU/ED settings.


pulmonary embolism, echocardiography, McConnell’s sign


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