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Management of right atrial appendage (RAA) thrombus is a clinical dilemma. We describe a case of incidentally found RAA thrombus in a patient with a left atrial appendage closure device (WATCHMAN). Options for the management of RAA thrombus include observation, anticoagulation, thrombolytics, or surgical extraction. Size, mobility, site of attachment of the thrombi, patient factors (e.g., bleeding risk), and other indications for anticoagulation may be used to guide management.

Right atrial appendage thrombus in a patient with a left atrial appendage occlusion device