Acute ischemic stroke is a condition with considerable mortality and morbidity. When used appropriately, Trans-esophageal Echocardiography (TEE) can be an incredibly useful tool to identify potential causes of stroke and guide management. The crucial distinction in this modality lies in separating common incidental findings from those likely to have contributed to ischemic stroke. Furthermore, the management of identified intracardiac causes varies widely from open surgery to antiplatelet therapy. This review seeks to discuss the role of TEE in identifying common etiologies of cardioembolic stroke, review the clinical entities, and the highlight the most recent management recommendations. (C) 2018 Elsevier Inc. All rights reserved.