The presence of right heart thrombi appears to increase the risk of mortality compared to the presence of pulmonary thromboemboli alone. The increased use of two-dimensional echocardiography has led to increased detection of these thromboemboli, particularly in patients with suspected or confirmed pulmonary emboli. The optimal management of the right heart thromboemboli remains unclear, but thrombolytic therapy with rt-PA appears to be rapidly effective in most patients resulting with complete resolution of the thrombus and improvement of pulmonary perfusion. Here, we present a case of free floating, worm-like thrombus in the right atrium which was lysed successfully by fibrinolytic therapy in a patient presenting with acute massive pulmonary embolism.