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The echocardiographic findings and case reports of three patients with active Streptococcal endocarditis and severe congestive heart failure are presented. All three had pathologically proven vegetations on the mitral valve; however, only the two with calcification of the vegetations were successfully demonstrated on echocardiography. Clinical and pathological differences are highlighted and prior case reports in the literature are reviewed. The nonspecific nature of echoes recorded from valvular vegetation is stressed and factors in their echocardiographic detection are discussed.
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