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A 67-year-old man with a known history of venous thromboembolism was admitted with a 2 week history of dyspnoea. He denied chest pain, leg swelling or recent travelling. Clinical examination revealed blood pressure of 124/68 mm Hg, regular pulse of 54 bpm and respiratory rate of 27/min. Jugular veins were distended at 7 cm, and cardiopulmonary examination revealed no findings. ECG showed sinus bradycardia, S wave in lead I, Q wave in lead III with T-wave inversion (S1Q3T3) (figure 1A). Troponin T was negative and NT proBNP was elevated at 937 pg/ml. CT pulmonary angiography showed bilateral pulmonary embolism (figure 1B). Transthoracic echocardiogram revealed a moderately dilated right ventricle (RV) with moderate dysfunction. The RV apex was hyperkinetic and the free wall segment was akinetic, a finding consistent with McConnell sign (figure 1C). Anticoagulation was started, and the patient was discharged home in a stable condition. A repeat echocardiogram 2 months later showed disappearance of McConnell sign (figure 1D).1 ,2
The role of transthoracic echocardiography in patients with pulmonary embolism is to evaluate haemodynamic stability, pulmonary hypertension and right ventricular (RV) strain.
The McConnell sign, identified as RV-free wall hypokinesia with hyperkinetic apex, is sensitive and specific in pulmonary embolism, and is associated with worse outcomes.
Contributors All authors have been involved in drafting the article and revising it critically for important intellectual content, and read and approved the final version of the manuscript.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.
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