Echogenic cardiac foci refers to a area in the heart where there
are abnormally high numbers of echoes
Cardiac echogenic foci are not uncommon findings during fetal
echocardiographic examination. They are located at the fetal ventricles
and have similar echogenicity to the surrounding bone tissue Echogenic
intracardiac foci were seen in the apical 4-chamber view in 100%
and in the lateral 4-chamber view in only 30% (5). Most echogenic
cardiac foci are located in an area of the left ventricle. However,
echogenic cardiac foci can also be found in the right ventricle.
In about 93% of cases, they are located in the left ventricle
and in 5% in the right ventricle; and bilateral in 2% (9).
The incidence of echogenic cardiac foci in 2nd trimester ultrasounds
ranges from 0.17% to 7.4% (2,3,7,9).
Increased local mineralization or calcification of papillary muscles
and chordae tendinae are thought to be the cause and the formation
of calcium or other minerals in the ventricles is thought to be
the cause of the increased echoing that leads to echogenic cardiac
foci. As evidence of this, a study of the heart tissue of unborn
children with Down syndrome found a significantly increased calcification.
Histological studies have shown these foci to be due to mineralization
within a papillary muscle (10).
In the differential diagnosis these structures
must be always differentiated from thrombi or cardiac tumours.
Echogenic foci in the heart have become an increasingly frequent
ultrasound finding. As with many ultrasound findings, there is
controversy about the significance of the foci. There is conflicting
evidence, however, as to whether echogenic foci in the heart lead
to an increased risk for Down syndrome. That is, some studies
have found that there is no increased risk (1), whereas others
have found that unborn children with echogenic cardiac foci are
four times more likely to have Down syndrome. Many studies suggest
that unborn children with echogenic cardiac foci have about a
1% chance of having Down syndrome IN 2003 Prefumo and AL report
that : An association exists between first trimester nuchal translucency
and second trimester cardiac echogenic foci. Then the Risk calculation
algorithms for trisomy 21 based on nuchal translucency thickness
should not use cardiac foci as an independent marker (4).
Echogenic cardiac foci are not an unusual or abnormal finding
in an echocardiography of the heart. In fact, up to 7.4% of unborn
children have echogenic cardiac foci when the mother is in the
second trimester. The vast majority of children with echogenic
cardiac foci are born normal and intacardiac foci found in low-risk
patients are not associated with a significant increase in the
risk of cardiac anomalies (7). This is especially the case for
the children of mothers who are under 35 years of age. Several
reports recently indicated an association with chromosomal trisomies,
particularly that of trisomy 21 (6) and Intracardiac echogenic
foci increase the risk of Down syndrome five- to seven-fold. This
information should be considered in the decision making for amniocentesis
in conjunction with the woman's background risk8.
Many of the cases of echogenic cardiac foci go away by themselves
by the time the child is born. In more than half of the cases
regress before 5 years of age and are not associated with significant
intracardiac or extracardiac anomalies (11).
Schechter AG, Fakhry J, Shapiro LR, Gewitz MH :
In utero thickening of the chordae tendinae. A cause of intracardiac
echogenic foci. J Ultrasound Med. 1987 Dec;6(12):691-5.
2. Dildy GA, Judd VE, Clark SL : Prospective evaluation of the
antenatal incidence and postnatal significance of the fetal echogenic
cardiac focus: a case-control study. Am J Obstet Gynecol. 1996
Oct;175(4 Pt 1):1008-12.
3. Homola J : [Are echogenic foci in fetal heart ventricles insignificant
findings?] [Article in Czech] . Ceska Gynekol. 1997 Oct;62(5):280-2.
4. Prefumo F, Presti F, Thilaganathan B, Carvalho JS : Association
between increased nuchal translucency and second trimester cardiac
echogenic foci. Obstet Gynecol. 2003 May;101(5 Pt 1):899-904.
5. Ranzini AC, McLean DA, Sharma S, Vintzileos AM : Fetal intracardiac
echogenic foci: visualization depends on the orientation of the
4-chamber view. J Ultrasound Med. 2001 Jul;20(7):763-6.
6. Wax JR, Philput C : Fetal intracardiac echogenic foci: does
it matter which ventricle?. J Ultrasound Med. 1998 Mar;17(3):141-4;
7. Wolman I, Jaffa A, Geva E, Diamant S, Strauss S, Lessing JB,
Yaron Y: Intracardiac echogenic focus: no apparent association
with structural cardiac abnormality. Fetal Diagn Ther. 2000 Jul-Aug;15(4):216-8.
8. Sotiriadis A, Makrydimas G, Ioannidis JP: Diagnostic performance
of intracardiac echogenic foci for Down syndrome: a meta-analysis.
Obstet Gynecol. 2003 May;101(5 Pt 1):1009-16.
9. Petrikovsky BM, Challenger M, Wyse LJ : Natural history of
echogenic foci within ventricles of the fetal heart. Ultrasound
Obstet Gynecol. 1995 Feb;5(2):92-4.
10. Tennstedt C, Chaoui R, Vogel M, Goldner B, Dietel M : Pathologic
correlation of sonographic echogenic foci in the fetal heart.
Prenat Diagn. 2000 Apr;20(4):287-92.
11. Liu HH, Lin MT, Chang CC, Wang JK, Wu MH, Shyu MK, Lee CN,
Hsieh FJ: Postnatal outcome of fetal cardiac echogenic foci. J
Formos Med Assoc. 2002 May;101(5):329-36.