Contrast-enhanced computed tomography (CT) was compared with 2-dimensional echocardiography (2-D echo) for evaluation of left ventricular (LV) thrombus. Thirteen patients with coronary artery disease who had LV thrombus initially documented by 1 of the 2 techniques were then studied with the other technique. The findings of the studies were concordant in 8 of 13 patients, with a similar description of the presence, location and size of the LV thrombus and associated regional LV wall abnormalities. In 5 of 13 patients, the 2 techniques produced discordant data. Of these, 2 patients had false-negative results on 2-D echo owing to poor visualization of the LV apex; 1 patient had a false-positive result on 2-D echo related to misinterpretation of a prominent papillary muscle; 2 patients had false-negative CT results, 1 related to insufficient contrast infusion. The findings demonstrate that CT is a useful technique for evaluating LV thrombus, and may be particularly helpful when 2-D echo is technically limited or equivocal.