McConnell's sign: an early and specific indicator of acute pulmonary embolism.

To cite: Patra S, Math RS, Shankarappa RK, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2013200799 DESCRIPTION A 76-year-old woman was admitted with acute onset of breathlessness with lethargy since the last 3 days. She was a known patient with hypertension and diabetes. On clinical examination, she had an engorged neck vein, tachycardia and tachypnoea, hypotension, oxygen saturation of 92% in room air and right ventricular S3 gallop with pansystolic murmur in the left lower parasternal area. ECG showed sinus tachycardia with an S1Q3T3 pattern. Chest X-ray did not reveal any significant abnormality. There was no elevation of cardiac biomarkers. Echocardiography revealed the presence of right atrial and ventricular dilation, moderate tricuspid regurgitation, severe right ventricular dysfunction, regional wall motion abnormality of the basal and mid right ventricular free wall with apical hyper contractility (McConnell’s sign), paradoxical septal motion and dilated inferior vena cava (figure 1A–C; videos 1–3). The CT pulmonary angiogram was suggestive of acute pulmonary embolism (APE) (figure 2). She was treated with infusion of streptokinase for 48 h, followed by an oral anticoagulant. McConnell’s sign is the most distinct echocardiographic finding described in patients with APE. There is a regional pattern of right ventricular dysfunction, with akinesia of the mid free wall and hyper contractility of the apical wall. McConnell’s sign is considered as a specific sign of APE. Though echocardiography has poor sensitivity, it