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Echocardiography is the most common imaging modality to visualize cardiac masses. However, sometimes it is difficult to distinguish between thrombus and cardiac tumors. Other imaging modalities should be used to delineate detailed anatomy of the cardiac masses. A 63-year-old white male with past medical history of coronary artery disease, myocardial infarct and coronary artery bypass graft surgery, was found to have a “cardiac mass” by a routine 2-dimensional echocardiogram. Echocardiogram revealed a large mass in left ventricle attached with a long narrow stalk to the apex. Contrast echocardiogram with DEFINITY revealed a non-opacified contrast defect in the left ventricular apex. It is very rare that apical thrombus has a long narrow stalk. Other possibilities such as cardiac myxoma or other cardiac tumors cannot be excluded. Cardiac magnetic resonance with and without contrast was therefore performed. It revealed a nonenhancing rounded thrombus within the apex. There was left apical thinning/ aneurysm with dyskinesis. Patient was treated with Coumadin for anticoagulation. He was doing well with current regimen.
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