Point-of-care ultrasound (POCUS) clip from a 60-year-old man with high-risk pulmonary embolism and concurrent acute ischemic stroke that contraindicated thrombolysis. The clip shows a large, highly mobile, serpiginous hyperechoic mass (ICOPER Type A thrombus-in-transit) occupying the right atrium, traversing the tricuspid valve, and extending into a dilated, hypokinetic right ventricle, with active migration toward the pulmonary circulation captured in real time. Supplementary audiovisual material for the case report. No patient-identifying data.