McConnell’s sign is not specific for acute pulmonary embolism – A case report

• Published in: Critical Care and Shock
• Main Author: Mohamad M.I.B.K.; Moktar M.F.B.; Noor J.A.M.; Karim N.A.; Ismail I.B.; Sanib A.H.B.; Mokhtar M.A.M.; Salim S.S.F.
• Format: Article
• Language: English
• Published: The Indonesian Foundation of Critical Care Medicine 2019
• Online Access: https://www.scopus.com/inward/record.uri?eid=2-s2.0-85075642228&partnerID=40&md5=69d71b4d29b598eca4a326fabde5aa3d

Since 1996, McConnell’s sign, defined as right free wall hypokinesia with apical sparing, described as one of the most specific echocardiographic finding for acute pulmonary embolism. It was incorporated in the standard teaching and text book as a tell-tale sign for the condition. This is a case report of a patient presented with chest pain and presyncope with markedly raised D-dimer and suspicious electrocardiogram finding. The bedside focused cardiac ultrasound revealed the classical McConnell’s. sign. However, the computed tomography pulmonary angiogram for pulmonary embolism was negative. The patient was subsequently diagnosed as pulmonary hypertension secondary from chronic methamphetamine abuse. This case highlights that McConnell’s sign is not specific for acute pulmonary embolism. It is also important to stratify patient according to a validated clinical probability score for pulmonary embolism before initiating definitive acute treatment. © 2019, The Indonesian Foundation of Critical Care Medicine. All rights reserved.