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Acute pulmonary embolism (PE) is a life-threatening illness that is an important cause of morbidity and mortality. Patients with extensive emboli usually have associated right ventricular (RV) dysfunction. With anticoagulation therapy, RV function usually returns to normal. In patients with massive and submassive PE, echocardiography may directly visualize the embolus or more commonly provide evidence of its haemodynamic sequelae. The McConnell's sign involving sparing of RV apical contraction coupled with akinesia of the RV free wall has previously been reported in patients with acute PE. We present a case of a patient who had massive acute PE with severe RV systolic dysfunction that was demonstrated with both conventional Doppler and strain imaging. Strain imaging was also able to demonstrate the rapid improvement of RV function in response to thrombolytic therapy.

Usefulness of right ventricular myocardial strain in assessment of response to thrombolytic therapy in acute pulmonary embolism