Beautiful capture of McConell's sign: RV free wall akinesia with sparing of apex.

But... Is it specific for PE? Poll & 🧵

👇🏽 https://twitter.com/HanCardiomd/status/1353158442194661376
What do you think? 🧐
Originally described in 1996 by McConnell et al. as akinesis of mid-RV free wall with normal apical contraction, he and his team found a sensitivity of 70% and specificity of 94% for PE in their validation cohort.

DOI: 10.1016/j.jemermed.2014.12.089
Originally described in 1996 by McConnell et al. as akinesis of mid-RV free wall with normal apical contraction, he and his team found a sensitivity of 70% and specificity of 94% for PE in their validation cohort.DOI: 10.1016/j.jemermed.2014.12.089
Originally described in 1996 by McConnell et al. as akinesis of mid-RV free wall with normal apical contraction, he and his team found a sensitivity of 70% and specificity of 94% for PE in their validation cohort.DOI: 10.1016/j.jemermed.2014.12.089
But has this amazing Sp endured the test of time? Not so much.

Though some studies managed to replicate great specificities (even reaching 100% 🤔):

PMID:
29174452
12208411
24075286
But has this amazing Sp endured the test of time? Not so much. Though some studies managed to replicate great specificities (even reaching 100% ):PMID:291744521220841124075286
But has this amazing Sp endured the test of time? Not so much. Though some studies managed to replicate great specificities (even reaching 100% ):PMID:291744521220841124075286
But has this amazing Sp endured the test of time? Not so much. Though some studies managed to replicate great specificities (even reaching 100% ):PMID:291744521220841124075286
They were all done in pts w/ suspected or known PE, whereas other studies that included different etiologies found an overall poor sp.

Like this one by Casazza et al. that evaluated its prevalence in PE confirmed pts vs RV infarction. Sp only 33%!

PMID: 15664548
They were all done in pts w/ suspected or known PE, whereas other studies that included different etiologies found an overall poor sp. Like this one by Casazza et al. that evaluated its prevalence in PE confirmed pts vs RV infarction. Sp only 33%!PMID: 15664548
They were all done in pts w/ suspected or known PE, whereas other studies that included different etiologies found an overall poor sp. Like this one by Casazza et al. that evaluated its prevalence in PE confirmed pts vs RV infarction. Sp only 33%!PMID: 15664548
Or this other study by Vaid et al. that included all pts w/ McConell's sign and found a PPV of only 57%! And it dropped even further to 40% when considering the subset of pts evaluated with echo before any other imaging modality:

PMID: 23948618
So what should we do with McConell's?

My take: a very useful sign suggestive of RV pressure overload, that might increase our suspicion of APE in the right pt but is not specific for the diagnosis. If pt is stable enough, always confirming w/ CTA is good practice.
Finally, I'll leave a cool case by @BrooksWalsh of a pt w/ McConell's and no vascular occlusion on CTA.

Hope you've enjoyed the thread!

DOI: 10.1016/j.jemermed.2014.12.089
Finally, I'll leave a cool case by @BrooksWalsh of a pt w/ McConell's and no vascular occlusion on CTA. Hope you've enjoyed the thread!DOI: 10.1016/j.jemermed.2014.12.089
Finally, I'll leave a cool case by @BrooksWalsh of a pt w/ McConell's and no vascular occlusion on CTA. Hope you've enjoyed the thread!DOI: 10.1016/j.jemermed.2014.12.089
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