UMEM Educational Pearls

Category: Critical Care

Title: How good is the McConnell sign for diagnosing pulmonary embolism?

Keywords: Pulmonary embolism, PE, echocardiography, ultrasound, hemodynamics, McConnell sign, right ventricle (PubMed Search)

Posted: 2/15/2011 by Haney Mallemat, MD (Updated: 1/27/2023)
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  • McConnell sign is right ventricular (RV) free wall hypokinesis with normal apical contraction on echocardiography.
  • Finding McConnell sign has been associated with submassive and massive pulmonary embolism (PE) when moderate to high clinical suspicion exists. This is important if unstable patients are unable to tolerate other diagnostic studies.
  • After its description, the specificity of McConnell sign’s for PE has been questioned, as other pathologies can produce it (e.g., RV infarction and severe pulmonary HTN).
  • The paper referenced below retrospectively found that the sensitivity, specificity, positive predictive value, and negative predictive value of McConnell sign for diagnosing PE was 70, 33, 67, ad 36%, respectively.
  • Bottom line: The McConnell sign must be used with caution if used alone to diagnose PE; especially if thrombolytics are being considered.

 

References

 

Casazza F., et al. Regional right ventricular dysfunction in acute pulmonary embolism and right ventricular infarction.Eur J Echocardiography 2005 Jan; 6(1): 11-4.