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Figure 4 Pitfalls in TEE screening for thrombi using the TEE-guided approach to cardioversion, including pectinate muscles (arrows) in the left atrial appendage (A), multilobed appendage (arrows) (B) and viscous spontaneous echocardiographic contrast, or "sludge" (C). Pectinate muscle tissue, multilobed appendage or sludge can be mistaken for thrombi, rendering a false positive TEE screening result. TEE = transesophageal echocardiography.