Failure of two-dimensional echocardiography to detect aspergillus endocarditis

Two-dimensional echocardiography has been shown to be a reliable diagnostic procedure in patients with valvular lesions due to fungal endocarditis. We describe a patient with four-chamber Aspergillus endocarditis localized to the nonvalvular endocardium. In this case, two-dimensional echocardiography failed to demonstrate cardiac abnormalities despite the presence of extensive endomyocardial disease at autopsy. The case emphasizes the diagnostic limitations of two-dimensional echocardiography in the absence of valvular vegetations.