Two-dimensional echocardiography (real-time ultrasonography) of the heart was used to detect adult Dirofilaria immitis in the right ventricle and atrium of a 2-year-old Labrador Retriever with occult heartworm disease and in 8 microfilaremic dogs. Adult worms were easily identified as parallel echogenic lines separated by a hypoechoic region. Images of worms fixed in formalin after recovery from dogs with experimentally induced heartworm infection had an identical appearance. The sensitivity of this imaging procedure was tested on the 8 dogs with naturally acquired infection, and worms were observed in the right ventricle of 7 of the dogs. Two-dimensional echocardiography appears to be a sensitive noninvasive procedure, which can be used in combination with thoracic radiography and serotests to improve accuracy of diagnosis of canine occult heartworm disease.