A 40 year old male comes to your ED with dyspnea. On arrival, his SpO2 is 88% on BiPAP, he is tachycardic in the 130s, and afebrile. You perform a bedside ultrasound and find the following seen below on parasternal short and apical four chamber views. What's the diagnosis? What 2 classic ultrasound findings are demonstrated in videos below? (scroll down for answer)

Answer: Pulmonary Embolism

• McConnell’s sign = regional pattern of acute RV dysfunction, often seen with PE

• Seen in apical 4 chamber view

• Difference between this and chronic RV dysfunction?

• Acute = akinetic RV wall with preserved/hyperkinetic apex

• Chronic = global wall motion abnormalities

• Often used as a ‘rule in’ parameter at bedside (typically most helpful with high 

• pretest probability)

• D sign = flattening of IV septum, forming a D-shape

• Seen in parasternal short axis view

• Often associated with RV overload 2/2 PE