Pulmonary Embolism
McConnell’s Sign
- Apical 4 Chamber View
- RV apex is only “contracting“ due to preserved LV function.
77% sensitivity and 94% specificity for diagnosing acute pulmonary embolism, a positive predictive value of 71% and a negative predictive value of 96%. It can also be seen in RV infarct or severe pulmonary hypertension (Foley, et al).
D Sign
- Parasternal Short Axis (mid-papillary level, mushroom view)
- “D-sign” is considered highly specific but low in sensitivity for a PE. One meta-analysis noted a sensitivity of 53% and a specificity of 83%.
In right ventricular pressure overload, patients will have an EI of > 1.0 (with D Sign) in BOTH end-systole and end-diastole, while in volume overload patients will have an EI > 1.0 (with D Sign) during end-diastole, and a normal eccentricity index (<1) during end-systole.
Is present in Pulmonary Embolism, Pulmonary Hypertension, Chronic Right Heart Failure with Hypertrophy, Left-sided heart failure, Acute Respiratory Distress Syndrome (ARDS).
