The diagnosis and treatment of left ventricular apical thrombi after myocardial infarction are still not well established. Fibrinolytic treatment, heparin treatment and surgical removal might be therapeutic options. We present the case of a 37 year old man who came into the Emergency department complaining of pleuritic chest pain. ECG revealed an evolving anterior wall infarction and transthoracic echocardiogram showed a big mobile thrombus in the ventricular apex. In order to confirm diagnosis and to differentiate other entities like pseudoaneurysm, contrast echocardiography and cardiac MRI with late gadolinium enhancement were performed and allowed a definitive diagnosis. Our patient was treated with intravenous heparin and then with oral anticoagulation. Two months later, echocardiogram showed an apical non-mobile and smaller thrombus.