The continuing enigma of the fetal echogenic intracardiac focus in prenatal ultrasound

Curr Opin Obstet Gynecol. 2013 Apr;25(2):145-51. doi: 10.1097/GCO.0b013e32835e14eb.


Purpose of review: The present article aims to review recent literature about intracardiac echogenic foci (ICEFs), with special emphasis in potential causes, relationships with aneuploidy and cardiac function.

Recent findings: The presence of an ICEF may be considered as a soft marker that may be of interest only in high-risk populations for chromosomal abnormalities. In cases of isolated ICEF in euploid fetuses there is not evidence of an altered cardiac function and a detailed echocardiogram is not recommended as long as the second trimester scan is normal. Cases of fetal myocardial diffuse or multiple calcifications may be related to inflammatory and hypoxic changes in fetal heart, but the relationships between these conditions and isolated ICEF remain unclear.

Summary: The origin of ICEF remains unclear. It is considered a normal developmental variant, but either inflammatory or hypoxic processes could be involved in its appearance. In low-risk populations for aneuploidy, the presence of an ICEF is not an indication for invasive procedures. In high-risk populations this depends on the previous calculated risk. In euploid fetuses, cardiac function is not significantly altered but further studies in specific populations may be justified. Fetuses with diffuse myocardial calcification or multiple foci may need further investigations.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Blood Flow Velocity
  • Calcinosis / diagnostic imaging*
  • Calcinosis / genetics
  • Calcinosis / physiopathology
  • Chromosome Disorders / diagnostic imaging*
  • Contrast Media*
  • Echocardiography, Doppler*
  • Female
  • Fluorocarbons*
  • Gestational Age
  • Heart Defects, Congenital / diagnostic imaging*
  • Heart Defects, Congenital / embryology
  • Heart Defects, Congenital / physiopathology
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Pregnancy
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography, Prenatal / methods


  • Contrast Media
  • Fluorocarbons
  • perfluoropentane