T wave inversions on electrocardiogram (ECG) can manifest from any process that result in a relative delay in regional ventricular repolarization. A variety of clinical syndromes can cause T-wave inversions, ranging from life-threatening events to entirely benign conditions. The differential diagnosis of precordial T wave inversion leads is not always straightforward and can represent the grey zone for cardiologists. Here the author describes the case of an otherwise healthy 84-year-old

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... n who presented to a cardiologist with an ECG that showed a normal sinus rhythm with T wave inversions across the anterolateral precordial leads of uncertain nature. Subsequent examinations by his general practitioner, such as exercise stress testing and echocardiography, showed inducible silent myocardial ischemia and the presence of left ventricular organized apical thrombus. The present case delineates the importance of recognizing this ECG pattern and, in the correct clinical setting, can facilitate the diagnosis and treatment of a relatively common medical condition.