Right heart thrombi are rare but carry high mortality risks, with untreated cases nearing 100%. Treatment options include anticoagulation, thrombolysis, and surgical thrombectomy, though no definitive guidelines exist. In this case, a 43-year-old male with an RV thrombus and bilateral pulmonary embolism responded well to half-dose thrombolytic therapy, with complete thrombus resolution and no bleeding events.