Red flag in bedside echocardiography for acute pulmonary embolism: remembering McConnell's sign

Abstract Dyspnea is a common symptom among emergency department (ED) patients. The differential diagnosis of dyspnea in ED patients is broad, and pulmonary embolism (PE) is a crucial consideration among these. Recognition of right ventricular (RV) dysfunction is critical in patients with PE. Here, w...

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Bibliographic Details
Published in:The American journal of emergency medicine 2013-04, Vol.31 (4), p.719-721
Main Authors: Ünlüer, Erden Erol, MD, Senturk, Güldehen Özmen, MD, Karagöz, Arif, MD, Uyar, Yasemin, MD, Bayata, Serdar, MD
Format: Article
Language:English
Subjects:
Aged
Cardiac arrhythmia
Computed tomography
Echocardiography - methods
Electrocardiography
Emergency
Emergency medical care
Humans
Hypoxia
Male
Medical imaging
Patients
Point-of-Care Systems
Pulmonary arteries
Pulmonary Embolism - diagnosis
Pulmonary Embolism - diagnostic imaging
Thromboembolism
Thrombosis
Tomography
Tomography, X-Ray Computed
Ultrasonic imaging
Veins & arteries
Ventricular Dysfunction, Right - diagnostic imaging
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Summary:Abstract Dyspnea is a common symptom among emergency department (ED) patients. The differential diagnosis of dyspnea in ED patients is broad, and pulmonary embolism (PE) is a crucial consideration among these. Recognition of right ventricular (RV) dysfunction is critical in patients with PE. Here, we present a 76-year-old male patient with the complaint of dyspnea. Focused cardiac ultrasonography performed by the emergency physician revealed enlarged RV, hypokinetic lateral wall and hyperkinetic apex of RV (McConnell's sign). We have screened the deep venous system of the patient with the linear probe for possible deep venous thrombosis and showed that the right dilated uncompressible popliteal vein had a thrombus formation. Computed tomography angiography of the thorax revealed filling defects in both main pulmonary arteries. Our case shows that bedside ultrasonography is a valuable tool for detecting PE and decision making in PE patients.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2012.12.007