We describe a case of cerebral emboli related to pulmonary venous thrombosis after bilateral lung transplantation in a young man with cystic fibrosis. The diagnosis was made by transesophageal echocardiography, leading to aggressive anticoagulation within 24 hours of surgery. Hemodynamic deterioration in the following hours was of concern for the development of obstructive thrombus but was found to be due to pericardial tamponade, which, remarkably, resolved during a repeat transesophageal echocardiography.