A mobile, free-floating thrombus found in the right heart, not attached to any intracardiac structure, is a clot-in-transit. This rare phenomenon is most commonly seen in patients with pulmonary embolism and diagnosed by ultrasound. With the advent of pulmonary embolism response teams (PERT), thorough evaluation of patients with PE includes transthoracic and/or transesophageal echocardiography, and therefore, the detection and incidence of clot-in-transit is increasing. A clot-in-transit carries an increased inhospital morbidity and mortality due to subsequent PE or paradoxical embolus in the presence of an intracardiac shunt. Most frequently treated with anticoagulation, other treatment options include surgery, mechanical thrombectomy, and systemic or catheter-directed thrombolysis. Clinical presentation, existing pulmonary artery clot burden, cardiac function, and thrombus size all play a role in the PERT treatment algorithm. However, there is minimal available data and no randomized clinical trials to guide which treatment options may provide optimal outcomes for patients with clot-in-transit.