Left atrial (LA) 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 the case of a left-ventricular-assist device where a correct diagnosis is of crucial significance. Intraoperative transesophageal echocardiography is an invaluable tool to detect an inverted LA appendage and differentiate it from other potentially dangerous diagnosis like LA 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 resurgery