Rheumatic heart disease is a sequelae of rheumatic fever. Mitral stenosis in rheumatic heart disease is common and leads to left atrial dilation and atrial fibrillation. Atrial fibrillation predisposes to thrombus formation in the left atrium and its appendage and is associated with embolic complications. Systemic embolism is frequent and associated with considerable mortality, especially in the developing world. Pulmonary embolism is rarely documented. Herein we report an extremely rare case of biatrial thrombus in a patient with rheumatic heart disease presenting as systemic as well as pulmonary embolism. Keywords: rheumatic, biatrial, thrombus, embolism