Train the eye - part 4. McConnell’s sign! #askpocus #echofirst #pocus @NephroP @Wilkinsonjonny @icmteaching @IMPOCUSFocus @dr_benoy_n_shah @cianmcdermott @EmergencyEcho @KalagaraHari @RJonesSonoEM @DRsonosRD @SonoSerious @iceman_ex @daniel_opazo
https://twitter.com/manoj_wickram/status/1329361665113067521
So what actually is McConnells sign?
https://twitter.com/sijunkimcv/status/1244707721120751619?s=21
It is a pattern of RV dysfunction characterised by Mid RV free wall akinesia and RV apical hyperkinesia
https://twitter.com/waltrickroberto/status/937302613632126978?s=21
The RV hyperkinesia gives a characteristic winking appearance....
https://twitter.com/manoj_wickram/status/1349001607577526272
Due to volume and pressure overload the RV is often significantly dilated.
https://twitter.com/sijunkimcv/status/1244707721120751619?s=21
McConnells sign is indicative of acute right heart strain and with the correct pre test probability can have very high specificity for PE (but importantly there are several other causes of this sign)
https://twitter.com/eusmkh/status/1270311529523675141
The sensitivity is low but will get higher the sicker the patient and bigger the PE is...
https://twitter.com/emnspeedofsound/status/941494365654016001
Other things to look for to differentiate between chronic and acute are RVSP (<60 acutely), PAT (<60 acutely), RV hypertrophy (element of chronicity)
https://twitter.com/boegel_kelly/status/1190019937382862848
A clot in transit makes your diagnosis much clearer!
https://twitter.com/eabramsmd/status/1049749661743898624
Spotting the pattern?
https://twitter.com/resaelewiss/status/1176841461234655238?s=21
Another clot in transit 🤢
https://twitter.com/dr_markman/status/1065260835667361792
In summary - a very helpful sign to spot and helps decision making, particularly TPA, in sick patients where you can’t wait for a CTPA
https://twitter.com/grepmeded/status/1189608468346560512
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