A Billiard Ball in the Left Atrium

An 84‐year‐old woman with a history of severe systolic heart failure, a mechanical mitral valve, and atrial fibrillation presented to the hospital with syncope and is found to have a free‐floating intracardiac mass on transthoracic echocardiogram that was absent 5 months earlier. Real time three‐dimensional (3D) transesophageal echocardiography (TEE) images reveal a billiard‐ball‐looking mass thought to be a large left atrial thrombus causing syncope by transiently obstructing the mitral valve orifice. Real time 3D TEE offers several potential advantages for the evaluation of intracardiac masses.