What's the Diagnosis? By Dr. Abby Renko

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



Posted by Jillian Smith, on Wed, 09/29/2021 - 7:58pm