title: McConnell's Sign Is Not Specific for Pulmonary Embolism: Case Report and Review of the Literature.
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.
  
  
  METHODS
  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.
authors.affiliation: Department of Emergency Medicine, Bridgeport Hospital, Bridgeport, Connecticut.
authors.forename: Brooks M
authors.initials: BM
authors.lastname: Walsh
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Moore
mesh_terms: D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D008180:Lupus Erythematosus, Systemic / Q000150:complications; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging*
keywords: McConnell's sign; echocardiography; emergency department; focused cardiac ultrasonography; pulmonary embolism; pulmonary hypertension