Cardiac thrombi often present as a homogenous echodensity on cardiac imaging that may be incidentally discovered. A thrombus must be differentiated from vegetations, tumors and normal variant anatomy as their treatments are different. Cardiac thrombi are often located in cardiac chambers, most commonly the left atrium and left atrial appendage, where there is more stagnant blood flow. Thrombi may also form in structurally altered cardiac chambers as well as seen in dilated cardiomyopathy and in

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... ventricular aneurysms. Symptoms, if present, may vary from dyspnea, angina and compressive symptoms. Currently, transthoracic echocardiography, transesophageal echocardiography and magnetic resonance imaging (MRI) are the accepted modalities to evaluate cardiac masses. MRI has been used with more frequency due to its ability to delineate mass borders, determine endocardial involvement and in its ability to detect blood flow. Few cases have been described of a large cardiac thrombus extending through the valves to include multiple chambers. In our case presentation, we describe a 91-year-old female with no significant cardiac history who presented with a non-ST elevation myocardial infarction where a transthoracic echocardiogram revealed a large intracavitary thrombus.