Left atrial appendage inversion is a rare event in cardiac surgery and can often be mistaken for a mass, thrombus or vegetation. This can be a challenge especially in case of a left ventricular assist device (LVAD) where a correct diagnosis is of crucial significance. Intra-operative TEE, is an invaluable tool to detect an inverted left atrial appendage and differentiate it from other potentially dangerous diagnosis like left atrial clot. Knowledge of this entity along with a high index of suspicion can help early diagnosis of this scenario and avoid unnecessary reinstitution of cardiopulmonary bypass and re-surgery