Left atrial thrombus can develop in patients with atrial fibrillation and/or a dilated left atrium such as seen in patients with heart failure. In cardiac transplant patients with bi-atrial anastomosis, the suture line can be a potential nidus for thrombus formation. These thrombi can be either organized or unstable with ulcerated surfaces. We present a unique case of a left atrial mass in a cardiac transplant patient with features of atrial myxoma on imaging studies but found to be an organized thrombus on histopathology.<>Learning objective: Left atrial thrombus formation in the cardiac transplant patient is a rare but serious condition. Most of the times it can be diagnosed with imaging studies but these noninvasive studies do not always give a definite diagnosis. We present a unique case of left atrial thrombus presenting as classic imaging features of atrial myxoma diagnosed after surgical resection. We emphasize that while treating these patients broad differential diagnosis should always be considered.>
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