Atrial fibrillation is associated with low-flow state and increased thrombogenicity in the left atrium (LA). Multiple echocardiographic presentations, including thrombosis, sludge, and smoke formation, have been demonstrated in just one biplane transesophageal echocardiographic view, along with normal structures, i.e., pectinate muscles and Coumadin ridge, which are highly educational for cardiologists.

We report a 51-year-old female with a history of a degenerated aortic bioprosthesis and severe valvular dysfunction who was admitted for redo valve surgery and unexpectedly developed acute flash pulmonary edema, a dramatic form of cardiogenic pulmonary edema before coronary angiography and was managed by timely and proper treatment.