Missing left atrial thrombus: dislodgement or artifact?

Patients with a left atrial thrombus are considered at high risk of thromboembolism. Surgical treatment is generally recommended. We experienced a case of a patient with a history of cerebral embolism related to chronic atrial fibrillation in whom, unexpectedly, no thrombi were found at thrombectomy. Although echocardiography is a useful method for detection of a thrombus in the left atrium, the possibility of a reverberation artifact should be routinely explored.