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Introduction: In patients indicated for detection of intraatrial thrombus (T), 2DTEE is routinely used. Differentiation between T and trabeculae/artifacts in left atrial appendage is often difficult. Real-time-3DTEE may bring new information facilitating the final decision.Methods: One hundred and ten consecutive patients (73M, age 64+-13) were examined by 2DTEE. In terms of possible presence of T, individual pts were diagnosed as negative (N2), uncertain trabecular finding (U2), other /bad image quality or ?artifacts/ (O2), and clearly positive (T2). Then, the RT3D TEE was applied and the categorization repeated (N3,U3,O3,T3). Finally, the operator decided whether the RT3DTEE 1: had an additional diagnostic value, and/or 2: changed the definite diagnosis of thrombosis.Results: N2:72 U2:14 O2:21 T2:2N3:96 U3:1 O3:12 T3:0The diagnosis was changed after RT3DE in 6 (suspicious T requalified definitely as musculi pectinati in 5, and requalified as just spontaneous echocontrast without T in 1). In 13, the operator was reassured of negative finding after RT3DTEE. In another 13, the findings remained unclear, mostly because of bad quality image. In the rest of pts, RT3DTEE was not helpful.Conclusion: RT3DTEE brings additional information, which can be helpful in differentiation of thrombus from other findings. It is particulary useful in identification of muscular trabeculae in the left atrial appendage.