Myopericarditis Presenting With McConnell's Sign: A Case Report and Literature Review

McConnell's sign is a classic echocardiographic finding most often encountered in the context of acute pulmonary embolism and is defined by severe hypokinesis or akinesis of the right ventricular free wall and hypercontractility of the apex. Despite having a high specificity for pulmonary embolism, other causes of McConnell's sign have been reported. This case is a rare presentation of McConnell's sign in association with myopericarditis. The patient presented with a systemic lupus erythematosus flare as well as acute pleuritic chest pain and was found to have significantly elevated high-sensitivity troponin, pericardial effusion, and McConnell's sign on echocardiography. Pulmonary embolism and underlying pulmonary hypertension were ruled out. The patient improved clinically with treatment of a systemic lupus erythematosus flare, and short-term follow-up echocardiography demonstrated resolution of right ventricular dysfunction. This case challenges the conventional diagnostic specificity attributed to McConnell's sign for pulmonary embolism by describing a similar pattern of regional right ventricular wall motion abnormalities in the setting of an inflammatory myopericardial syndrome. Additionally, it underscores the utility of speckle-tracking strain analysis to help differentiate potential etiologies in right ventricular dysfunction. This case demonstrates the importance of having a broad differential when encountering McConnell's sign and represents an underappreciated cause of McConnell's sign associated with myopericarditis.