An echogenic intracardiac focus (EIF) is a relatively common finding, even in otherwise normal fetuses. It is not a structural abnormality and considered a normal variant representing calcified deposits in the muscle of the fetal heart that appear as bright spots on prenatal ultrasound. SMFM considers an EIF a “soft marker” which is a “minor ultrasound finding” associated with an increased risk of aneuploidy.
If EIFs Are Seen in Isolation
If Other Anomalies are Present
Note: SMFM guidance does not recommend diagnostic testing for isolated soft markers if aneuploidy screening is negative, but supports offering diagnostic testing as an option to all pregnant people regardless of aneuploidy risk
An EIF is the presence of a small (< 6mm) echogenic area in one or both of the cardiac ventricles, observed in at least two planes (ex. 4 chamber view, left ventricular outflow tract view) and as bright as bone. EIF may also be referred to as a papillary muscle microcalcification. EIFs are a fairly common second trimester finding, seen in 3 to 5% of euploid fetuses. Older studies described EIF as a soft marker for Trisomy 21, but subsequent literature has suggested a minimal risk with an isolated EIF.
ACOG Practice Bulletin 226: Screening for Fetal Chromosomal Abnormalities
ACOG Practice Bulletin 162: Prenatal Diagnostic Testing for Genetic Disorders
ACOG Practice Bulletin 175: Ultrasound in Pregnancy
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