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A white man aged 53 years, with a history of anterior myocardial infarction, was referred to our echocardiography laboratory because of worsening dyspnea and fatigue. In a few months, his New York Heart Association functional class had passed from IIb to III and IV. A previous transthoracic echocardiography (TTE) showed an enlarged and hypertrophied left ventricle with a markedly depressed systolic function (ejection fraction of about 30%). The patient was on maximal and tolerated medical therapy, according to current guidelines for treatment and management of chronic heart failure. A TTE was performed, and it showed a huge thrombus occupying most of the left ventricle (Fig. 1A). The massive thrombus was secondary to the severely reduced left ventricle function, not allowing adequate filling and contributing to intractable heart failure. The thrombus originated from an aneurysmof the left ventricle, occupying almost two-thirds of the ventricle itself (Fig. 1, B andC;Video 1 , view video online).