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Echogenic intracardiac focus

Echogenic intracardiac focus (EIF) is a relatively common sonographic observation that may be present on an antenatal ultrasound scan.

Epidemiology

They are thought to be present in ~4-5% of karyotypically normal fetuses. They may be commoner in the Asian population 5

Pathology 

They are considered to represent mineralisation within papillary muscle.

Location

The majority of echogenic intracardiac foci are unilateral. Out of all the cardiac chambers, the left ventricle is the most frequent in terms of location.

Associations

Radiographic features

Antenatal ultrasound

They are typically seen as a small bright echoic focus within the fetal heart on a four chamber view (often as bright as bone).

Significance

  • the presence of an echogenic intra cardiac focus has to be interpreted in the context of maternal risk factors and other sonographic anomalies
  • when seen in isolation in a normal pregnancy it is considered a benign variant 
  • in high risk pregnancies, there is an increased incidence of aneuploidic anomalies 
  • it is therefore sometimes classified as soft marker for aneuploidic anomalies.
  • the presence of multiple or bilateral (more than one chamber) echogenic foci may increase the risk
  • there is no recognised direct association with congenital heart disease for a EIF on its own 1 (unless there is an associated aneuploidic anomaly) 
Natural course

They usually disappear during the 3rd trimester 7.

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