Echogenic intracardiac focus Implications

By Cashmere Lashkari, B.Sc.Reviewed by Dr. Liji Thomas, MD

A pregnancy can be an exhilarating and exhausting experience. There are so many changes taking place rapidly within the woman’s body, internally as well as externally. The expecting mother may often be overwhelmed with issues that she had no way to expect.

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One such issue could be the presence of an echogenic intracardiac focus in the fetus, a condition that becomes apparent during an antenatal ultrasound.

What is an Echogenic Intracardiac Focus?

Sonography or ultrasound is a procedure performed on pregnant women to evaluate how the fetus is developing. It allows the attending health care professional to assess the state of the fetus in a non-intrusive manner. Sonography is a painless technique which uses sound waves of high frequency to produce the image of the fetus.

Sometimes the ultrasound professional may spot a bright area within the heart region. This bright spot, which is usually seen in the ventricle of the heart, is referred to as an echogenic intracardiac focus. It is not a defect or a disease.

It is usually the site of a small calcium deposit. It is generally found in the left ventricle of the heart due to the direction of flow of blood but may be seen in the right ventricle as well. If more than one bright spot is found, they are referred to as echogenic intracardiac foci.

Symptoms and risk factors associated with this condition

It is important to remember that the presence of an echogenic intracardiac focus is not unusual. Routine fetal ultrasounds may show this condition, which may be a reason to refer the pregnant woman for fetal echocardiography.

This second-level test is performed to check for the risk of congenital heart defects in the infant. Often the pregnant woman will be asked to undergo an amniocentesis, should the health care professional suspect a genetic or other problem with the fetus.

The echogenic intracardiac focus is usually caught on an ultrasound examination in the first trimester ( about 14 weeks of pregnancy). In some cases, the condition disappears by the time the pregnant woman comes in for her next ultrasound in the second trimester.

However, in the majority of cases the condition persists into the third trimester, even though its size is considerably reduced by this time. It typically disappears towards the latter part of the third trimester.

In normal pregnancies the presence of an echogenic intracardiac focus is viewed as a benign variant. However, in high risk pregnancies it may be seen as a soft marker for aneuploidic anomalies such as Down syndrome and trisomy 13. The presence of multiple echogenic intracardiac foci may be seen when there is an increased risk of congenital heart disease.

Implications of an echogenic intracardiac focus

In the majority of patients, the echogenic intracardiac focus is representative of a calcification or a microscopic fibrosis inside the papillary muscle. The presence of the bright spot on the ultrasound imaging may also be another condition altogether.

For instance, fetal cardiac tumours like rhabdomyomas may become calcified and show up as an echogenic intracardiac focus. This is the reason for referring the fetus for careful echocardiography.

Another condition which can mimic the appearance of an echogenic intracardiac focus is endocardial fibroelastosis, which is a rare heart disease found in babies. Here, the endocardiaum of the fetal heart becomes calcified or is affected by fibrosis. This causes the muscular lining of the heart chambers to thicken in order to support the increased thickness of the endocardium.

What further tests are recommended?

Should it be a high-risk pregnancy, the health care professional will recommend an amniocentesis. This is to rule out the possibility of chromosomal anomalies. This test will be able to determine if any genetic mutation has taken place in the fetal chromosomes. It will also be able to predict fairly accurately what these changes will mean for the general health and wellbeing of the baby after birth.

Other prenatal screening tests may be recommended based on the results of the amniocentesis. If the health care professional deems that the echogenic intracardiac focus is a normal variant, nothing further may need to be done. This is especially if the amniocentesis comes back negative, ruling out mutations of the fetal chromosomes.

Treatment and other options

The condition is seen predominantly in Asian pregnancies and is very rarely an indication of a serious problem. As stated above, in the majority of cases the echogenic intracardiac focus is seen to disappear in the latter half of the third trimester.

The bright spot seen in the initial ultrasound has a tendency to constantly decrease in size as the pregnancy progresses. While monitoring of the condition is necessary, in most cases the baby will be born without complications and in good health. Other tests and treatments will be required only if the amniocentesis throws up a disturbing finding.

Further Reading

• All Echogenic Intracardiac Focus Content
• What is an Echogenic Intracardiac Focus?