A 57-year-old woman, with a history of recurrent deep venous thromboses, was admitted for progressive dyspnoea rapidly improved by diuretic treatment; her electrocardiogram showed deeply inverted T-waves in precordial leads. Pulmonary embolism was dismissed by a normal lung scan. Early coronary angiography was completely normal. However, echocardiography revealed a bilobulated mass attached to the apex of an apparently normally contracting LV, compatible with mural thrombus ( Fig. 1 A; Video 1 ), prompting heparin therapy.

A. Transthoracic echocardiography shows a bi-lobulated mass attached to the apex of the left ventricle. B. Cardiovascular magnetic resonance: inversion recovery delayed-enhanced four-chamber left ventricle view acquisition with phase-sensitive detection demonstrates the resolution of the intracardiac mass after anticoagulation and subendocardial delayed enhancement pattern of ischaemia in the related left ventricle apex.

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