biostudies-literatureUnknown26(3)Malerba CMcConnell's sign, characterized by hypokinesia of the mid-free wall of the right ventricle (RV) with preserved apical contractility, is a well-recognized echocardiographic marker in acute pulmonary embolism (PE). However, its reverse variant-apical akinesia with preserved basal function-is rare and less understood. We report the case of an 85-year-old woman presenting with acute PE, who exhibited a rare form of RV dysfunction known as Reverse McConnell's sign. Multimodality imaging-including computed tomography (CT), transthoracic echocardiography, and cardiac magnetic resonance (CMR)-revealed apical RV akinesia and a concurrent intracavitary thrombus at the RV apex. Based on imaging, laboratory biomarkers, and clinical findings, an intermediate-high risk PE was diagnosed. The patient was Heart views : the official journal of the Gulf Heart Association198-203https://www.ebi.ac.uk/biostudies/studies/S-EPMC12697744biostudies-literatureMultimodality Imaging Evaluation of Reverse McConnell's Sign and Right Ventricular Apical Thrombosis in Acute Pulmonary Embolism.PMC12697744Malerba CCamastra GCiolina FBadagliacca RSbarbati SCacciotti LArcari LfalseMultimodality Imaging Evaluation of Reverse McConnell's Sign and Right Ventricular Apical Thrombosis in Acute Pulmonary Embolism.McConnell's sign, characterized by hypokinesia of the mid-free wall of the right ventricle (RV) with preserved apical contractility, is a well-recognized echocardiographic marker in acute pulmonary embolism (PE). However, its reverse variant-apical akinesia with preserved basal function-is rare and less understood. We report the case of an 85-year-old woman presenting with acute PE, who exhibited a rare form of RV dysfunction known as Reverse McConnell's sign. Multimodality imaging-including computed tomography (CT), transthoracic echocardiography, and cardiac magnetic resonance (CMR)-revealed apical RV akinesia and a concurrent intracavitary thrombus at the RV apex. Based on imaging, laboratory biomarkers, and clinical findings, an intermediate-high risk PE was diagnosed. The patient was 2025-01-01T00:00:00Z2025 Jul-Sep2026-05-26T11:06:49.598Z2026-05-24T03:12:17.983ZS-EPMC126977444139381910.4103/heartviews.heartviews_113_25