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Soft Markers
Echogenic foci in the fetal heart

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A small area within the fetal heart with echogenicity equal to or greater than the surrounding bone.


There is histological evidence that these areas represent calcification often within the papillary muscle(Reference1), the underlying reason for their presence is unknown (Reference2).

Standard image for identification/exclusion

In a standard four chamber view of the heart, echogenic foci are seen in close proximity to papillary muscles and should move in synchrony with the valve leaflets.

They should be verified in a long axis view. They are most common in the left ventricle but can be found in the right or bilaterally. They are discrete lesions and should not be confused with diffuse areas of echogenicity, which are an indication of a more general problem in the myocardium (Reference3).

Technique for measurement/assessment

The number and location of the foci should be assessed.

The ultrasound assessment should be completed, looking in particular for the other soft markers: nuchal pad, echogenic bowel, short femur, renal pyelectasis and choroid plexus cysts.

Implications for a positive finding in isolation

There is no association with cardiac defects and referral for echocardiography is not required in the absence of other indications. There is no evidence that they affect cardiac function. A prevalence of 3-5% has been described in the low risk population (Reference4) and most will disappear prior to delivery or in the early neonatal period.

There is a weak association with trisomy 21 in conjunction with other markers, but in isolation no further action is required.

Image 3 - Echogenic foci in the fetal heart



1. Robert DJ, Genest D. Cardiac histologic pathology characteristic of trisomies 13 and 21. Hum Pathol 1992; 23: 1130-40, Abstract

2. Pathologic correlation of sonographic echogenic foci in the fetal heart. Prenat Diagn 2000; 20: 287-292, Abstract

3. Bronshtein M, Jakovi P Ofrir C. Multiple fetal intracardiac echogenic foci:not always a benign sonographic finding. Prenat Diagn 1996; 16:131-5, Abstract

4. Achiron R, Lipitz S, Gabbay U, Yagel S. Prenatal ultrasonographic diagnosis of fetal heart echogenic foci: no correlation with Down syndrome. Obstet Gynecol 1997; 89:945-8 , Abstract


© Perinatal Institute 2011