A 50-year-old female presented to our emergency department with complaints of acute onset pain in left lower limb for last 5 days. Her previous history was unremarkable. Physical examination revealed a pulse rate of 90 per minute, blood pressure of 120/76 mm Hg and normal jugular venous pulse. The left lower limb was cold and pale. Her left femoral, left popliteal, left dorsalis pedis and left posterior tibial arterial pulsations were absent. All other arterial pulsations were normally present. Cardiac and respiratory examinations were within normal limits. Electrocardiogram was within normal limits with normal sinus rhythm. A diagnosis of acute limb ischemia was made and an emergency computed tomographic angiography of infra renal aorta with both the lower limbs was done. There was a partial filling defect of the aorta just before the bifurcation along with complete thrombotic occlusion of the left common iliac artery with distal reformation by collateral from the arteries of the contralateral limb (Fig. 1). Two dimensional echocardiography showed a large (2.0 × 3.0 cm) mobile thrombus at the apico-septal region of the left ventricle along with normal ejection fraction of 60% (Fig. 2A, Supplementary movie 1). The three dimensional (3D) nature of the thrombus was better appreciated on transthoracic 3D echocardiography (Fig. 2B, Supplementary movie 2). Hematologic studies revealed anemia, with hemoglobin level of 10 g/dL, thrombocytopenia (30 platelets/nL) and leucocytocis (240 white blood cells/nL). Peripheral smear showed 95% blast cells which were peroxidase negative (Fig. 3). Bone marrow aspiration confirmed the diagnosis of acute myeloid leukemia (French American British type M2). Aortic with left ileo-femoral thromboembolectomy was done to salvage the limb. Intra venous heparin therapy was started for left ventricular thrombus. Patient was transferred to the oncology department where induction phase of chemotherapy was started according to acute myeloid leukemia management protocol.