A 55-year-old man was seen with palpitations, dyspnea, syncope, and a large apical left ventricular mass. A diagnosis of apical hypertrophic cardiomyopathy had been made by cardiac catheterization 10 years previously. Transthoracic echocardiography performed during the current evaluation, however, was suggestive of a primary cardiac tumor. At operation, a large fibroma was excised. Knowledge of the echocardiographic appearance of apical left ventricular abnormalities can be helpful in determining the most appropriate choice of therapy.