A case report of mobile, right heart thrombus in the accident and emergency (A&E) department is presented. Though frequently associated with major pulmonary embolism, recognition is usually at postmortem examination. Detection of the presence of mobile thrombus in the right heart by early echocardiogram and prompt treatment may be life saving. Surgical or medical treatment options are dependent on local facilities. Early specialist involvement with a contingency plan in A&E departments are advised.
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