The sonographic finding of a McConnell’s sign, defined as right
ventricle (RV) hypokinesis with apical sparing, has been described in
the setting of pulmonary embolism (PE) and RV infarction. Patients with
PE and RV infarction can have similar clinical presentations, and a
rapid way to discriminate between these etiologies may improve care for
these critical patients. While a McConnell’s sign due to PE typically
results in a right-to-left ventricle ratio of ≥ 1, we observed three
cases of a McConnell’s sign due to RV infarction resulting in a
right-to-left ventricle ratio of < 1. One patient expired
after their electrocardiogram demonstrated an inferior myocardial
infarction, and two patients survived with stenting of the right
coronary artery. In addition to the McConnell’s sign, the RV was smaller
than the LV in all three patients. Emergency physicians should be aware
that RV infarctions can present with a McConnell’s sign demonstrating an
RV-to-LV ratio <1. We propose this ratio may help to
distinguish an RV infarction from PE in the undifferentiated patient
with McConnell’s sign. Given the rarity and higher mortality of RV
infarction relative to PE, it is important to consider both diagnoses
when performing cardiac PoCUS on critical patients.
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