DISCUSSION: The most common causes of a LV apical mass on TTE include an LV thrombus and false tendons. However, there was no evidence of wall motional abnormality, no history of recent myocardial infarction (MI), and no history of valvular dysfunction or arrhythmia, making a thrombus less likely. Due to patient’s history of TSC, there was also concern for a cardiac rhabdomyoma, which is one of the major clinical features of TSC. In fact, 50% of patients with cardiac rhabdomyomas have a diagnosis of TSC. Cardiac rhabdomyomas are less likely in this patient, as they more commonly occur in children, are typically seen in the right ventricle or atrium, and are more invasive . MFF, however, are benign, well-circumscribed round or linear deposits with unique fatty attenuation (demonstrated by -63.42 HU) and are more commonly present in the left ventricular wall [1,2].