Echogenic intracardiac focus (EIF) is a relatively common sonographic observation that may be present on an antenatal ultrasound scan.
They are thought to be present in ~4-5% of karyotypically normal fetuses. They may be more common in the Asian population 5.
They are considered to represent mineralization within the papillary muscles.
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.
The tightness of the association between an isolated EIF and aneuploidy continues to be debated. Biventricular EIFs are considered to be a higher risk for aneuploidy.
They are typically seen as a small bright echoic focus within the fetal heart on a four chamber view (often as bright as bone).
Tissue harmonic imaging should be turned off when evaluating a potential EIF, to avoid false positives. If it is difficult to tell if the EIF is as bright as bone, the gain in the image can be decreased to see which structure disappears first.
It is usually single and less than 3 mm.
It needs to be differentiated from normal papillary muscle which is not as bright as bone and a moderator band which is situated at the ventricular apex.
Treatment and prognosis
- the presence of an echogenic intracardiac 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 and some authors state karyotyping is unwarranted in the mid-trimester fetus with an incidental finding of fetal heart echogenic focus 8
- in high-risk pregnancies, there is an increased incidence of aneuploidic anomalies (e.g. Down syndrome 2,3 and trisomy 13 3)
- classified as a soft marker for aneuploidic anomalies
- the presence of multiple or bilateral (more than one chamber) echogenic foci may increase the risk
- there is no recognized direct association with congenital heart disease for an EIF on its own 1 (unless there is an associated aneuploidic anomaly)
They usually disappear during the 3rd trimester 7.
- 1. Wax JR, Cartin A, Pinette MG et-al. Are intracardiac echogenic foci markers of congenital heart disease in the fetus with chromosomal abnormalities? J Ultrasound Med. 2004;23 (7): 895-8. J Ultrasound Med (full text) - Pubmed citation
- 2. Manning JE, Ragavendra N, Sayre J et-al. Significance of fetal intracardiac echogenic foci in relation to trisomy 21: a prospective sonographic study of high-risk pregnant women. AJR Am J Roentgenol. 1998;170 (4): 1083-4. AJR Am J Roentgenol (abstract) - Pubmed citation
- 3. Winter TC, Anderson AM, Cheng EY et-al. Echogenic intracardiac focus in 2nd-trimester fetuses with trisomy 21: usefulness as a US marker. Radiology. 2000;216 (2): 450-6. Radiology (full text) - Pubmed citation
- 4. Bradley KE, Santulli TS, Gregory KD et-al. An isolated intracardiac echogenic focus as a marker for aneuploidy. Am. J. Obstet. Gynecol. 2005;192 (6): 2021-6. doi:10.1016/j.ajog.2005.03.033 - Pubmed citation
- 5. Shipp TD, Bromley B, Lieberman E et-al. The frequency of the detection of fetal echogenic intracardiac foci with respect to maternal race. Ultrasound Obstet Gynecol. 2000;15 (6): 460-2. doi:10.1046/j.1469-0705.2000.00138.x - Pubmed citation
- 6. Carriço A, Matias A, Areias JC. How important is a cardiac echogenic focus in a routine fetal examination? Rev Port Cardiol. 2004;23 (3): 459-61. - Pubmed citation
- 7. Entezami M, Albig M, Knoll U et-al. Ultrasound Diagnosis of Fetal Anomalies. Thieme. (2003) ISBN:1588902129. Read it at Google Books - Find it at Amazon
- 8. Achiron R, Lipitz S, Gabbay U, Yagel S. Prenatal ultrasonographic diagnosis of fetal heart echogenic foci: no correlation with Down syndrome. Obstetrics and gynecology. 89 (6): 945-8. Pubmed
- 9. Anderson N, Jyoti R. Relationship of isolated fetal intracardiac echogenic focus to trisomy 21 at the mid-trimester sonogram in women younger than 35 years. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology. 21 (4): 354-8. doi:10.1002/uog.89 - Pubmed
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