Introduction Right ventricular thrombi are uncommon, usually found with concurrent pulmonary emboli and associated with significant mortality. They often originate from deep vein thrombi but may also be due to primary intracardiac processes . A right ventricular thrombus can be an unexpected marker for underlying malignancies, including esophageal cancer. This occurs due to the hypercoagulable state often induced by malignancy. Here we report a presentation where the identification of a right ventricular thrombus led to the diagnosis of esophageal cancer. Case Presentation Our patient is a 57-year old male with no past medical history who experienced an episode of dizziness . On admission vitals and physical examination were within normal limits. Electrocardiogram showed normal sinus rhythm, white blood cell count of 31, elevated troponins at 187. Echocardiogram was ordered as part of syncope /presyncope evaluation to rule out any structural/functional abnormalities.On transthoracic echocardiogram, there was a hypoechoic, irregularly shaped, partially mobile structure partially adherent to the free wall of the right ventricle, measuring 35 x 12.6mm. A computed tomography scan was done to rule out pulmonary embolism. This revealed no evidence of pulmonary embolism but incidentally patchy consolidative opacities of the left lower and upper lung lobes, mediastinal hilar lymphadenopathy, numerous hepatic hypodensities, lytic lesions of the thoracic spine,and an esophageal junction mass. Endoscopy revealed a gastro esophageal junction mass. Biopsy revealed moderate to poorly differentiated adenocarcinoma.The decision was made to percutaneously aspirate the right ventricular mass as it was highly mobile and large , placing it at high risk for embolization and related complications.Pathology of the specimen confirmed it to be a thrombus . Patient was not a surgical candidate as per surgical oncology consultation due to extensive metastatic disease. Learning Points There is no literature to show cases wherein a right ventricular thrombus led to the discovery of malignancy.A right ventricular thrombus is dangerous because of the risk of embolization. The thrombus can potentially break off and travel to the pulmonary arteries, causing a pulmonary embolism or impair the right ventricle’s ability. The discovery of a right ventricular thrombus in an otherwise unexplained clinical context should prompt a thorough evaluation. A hypercoagulable or prothrombotic state of malignancy occurs due to the ability of tumor cells to activate the coagulation system. Future studies assessing the best advanced therapy for a right ventricular thrombus are necessary.