Pulmonology Book


Echocardiogram in PE

Aka: Echocardiogram in PE, Pulmonary Embolism Evaluation with Echocardiogram, Right Ventricular Heart Function Evaluation in Pulmonary Embolism, McConnell's Sign
  1. See Also
    1. Echocardiogram
    2. Pulmonary Embolism
  2. Technique
    1. Best views to estimate right ventricular function
      1. Apical four chamber view
      2. Parasternal short axis
  3. Imaging: Right ventricular dysfunction signs suggestive of increased right heart pressures
    1. Right ventricular dilation (RV diameter compared with LV) on apical four chamber view
      1. Right ventricle is normally 2/3 the size of the left ventricle
      2. Abnormal if RV is the same size or larger than the left ventricle
    2. Acute RV dilation findings (contrast with chronic RV dilation of COPD and other Cor Pulmonale)
      1. Right ventricular free wall thickness <0.5 cm in end diastole
    3. Right ventricular wall contractility decreased
    4. D-Shaped left ventricle (PSAX View)
    5. McConnell's Sign
      1. Dilated right ventricle with RV free wall akinesis and normal apical contractions
      2. Right ventricular apex contracts normally
      3. Right ventricular free wall does not contract
      4. Sosland (2008) Circulation 118(15):e517-8 +PMID:18838568 [PubMed]
    6. Flattening or paradoxical movement of the septum in PSAX View
    7. Inferior Vena Cava dilation
    8. 60/60 Sign
      1. Right ventricular outflow tract doppler flow acceleration time cut-off at <60 ms
      2. Pulmonary artery systolic pressure 30-60 mmHg
  4. Differential diagnosis: Echocardiogram with right heart dysfunction
    1. Chronic Pulmonary Hypertension
      1. Right ventricle wall thickness >0.5 cm
    2. Cardiac Tamponade
    3. Right-sided Myocardial Infarction
  5. References
    1. Swaminathan, Valois and Lanctot in Herbert (2019) EM:Rap 19(6): 6-8
    2. Orman, Dawson and Mallin in Herbert (2013) EM:Rap 13(1): 4-6
    3. Swaminathan and Avila in Herbert (2020) EM:Rap 20(5):10

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