Echogenic Foci in ultrasound

Specialties Ob/Gyn

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hello lovely OB nurses! I have a question I'm hoping you will set aside my past posts on the board to answer anyway :)

what, exactly, is the significance of echogenic foci on baby's heart in ultrasound?

I know it is a *SOFT* marker for Trisomy 21 (Down's). At a 14w ultrasound the tech specifically mentioned that the nuchal fold was not thickened, and that the nasal bone (at that point cartilige) was present and accounted for, both good signs against Trisomy 21. She did not mention either during the 22w ultrasound although I know she did measure the nuchal fold, and judging from the baby's profile the nasal bone is definitely there!

So what ELSE can it mean? Is there a chance of heart defect, or is it just a case of "baby's heart was in a bad position for picture taking that day" - she did have a hard time getting a good picture of all 4 chambers because baby's back was facing outward.

Second, is there any significance that there was, presumably, more than just one echogenic focus on the heart (midwife said "and the echogenic foci were all resolved?" leading me to believe there was more than one)

I declined AFP so I don't have that result to look at either.

The background story:

I have had 3 ultrasounds during this pregnancy: 6w 1d, 14w 5d and 22w 5d. Obviously at the 6w ultrasound they couldn't have seen echogenic foci. The 14w ultrasound was because I was larger than dates and my MW wanted to rule out multiples or incorrect dates from the first ultrasound (I had no idea when the baby was conceived) so it was short and to the point. After that US one of the doctors came in and read the result right there, and said everything was 100% perfect, baby measuring bingo for dates, all looks good, congrats. The 22w ultrasound was the "Level 2" ultrasound and the tech told me my MW would go over the results at my next appointment.

Well when I went in for my next appt the midwife was just sort of breezing over everything and asked, "so did you have a follow-up ultrasound done?" I was confused to say the least, and said "well, I don't think so; I had the Level 2 two weeks ago but nothing since then " THEN she dropped this on me "and the echogenic foci were all cleared up right?" WELL HOW DO I KNOW, no one said anything to me, this was the first I'd even heard that there WERE echogenic foci.

Obviously at my next appointment I plan to make her clarify this! But that's another week away and while I'm not *SUPER* worried I'd like a bit of reassurance if you can offer it .

the only info I'm googling is going over the significance of Echogenic Foci with regard to Trisomy 21 (which, by the way, appears to be the source of much controversy!)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

I can't even begin to speak on this. You need a perinatologist's opinion and help here. I just wish to extend you the warmest wishes for a healthy pregnancy and baby. Please let us know what you find out and how things go. Take good care.

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Specializes in Maternal - Child Health.

Are they referring to suspected calcium deposits in the baby's heart? I know of one case where the baby had calcium deposits on his liver. He was also diagnosed prenatally with an intestinal obstruction, so there was a suspicion of Down's Syndrome, but the baby was perfectly normal, and did well following surgery. I've never heard of calcium deposits in the heart, though.

I agree you need a specialist consult in order to gain an understanding of these findings. Best wishes to you.

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hmm, was afraid of that. Guess I'll wait out the week and ask her then :D thanks anyway ladies

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why don't you just call her today? tell her you are agonizing over the stress and confusion of the situation. i don't know anything about ultrasounds, but i can tell you're worried and you shouldn't have to be if there is not a problem. first you need to know that there isn't one and get some clarification. people should be explaining all of this to you more clearly. best of luck to you and your new family!

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Yes, I agree w/imenid. Don't wait. CALL HER TODAY. You have the right to know what is going on and not to have to wait, especially if you suspect something is amiss.

I did NOT mean to brush you off. I am very concerned you get good news. I just meant, I would be in WAY over my head to even try to discuss this level US with you and the implications. It would be SO inappropriate for me to do so since I am not versed in ultrasonography, especially as it relates to perinatology and high-risk obstetrics.

I honestly wish you the best outcome and health and hope for good news for you. I would ask you to PLEASE let us know what you find out, if you care to share. I am going to check back and see how you do, OK? Fingers crossed for you and your family! we do CARE!!!!

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oh, no please don't think I think you're giving me the brush-off. And honestly I'm not *that* worried, which is why I am OK with just waiting a week - heck I've sat on it for the last 3 weeks, one more week of wait won't make a difference LOL

I will post back when I do have an answer though

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Sorry that I never got back to you one this. :imbar I can't get back there. :(

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don't worry about it nursey :) I've pretty much got things figured out I think. I did call the MW (of course on vacation LOL) and am expecting her to call back Monday to clarify what's up. It's not as big a deal as I first thought, I suspect; in fact I finally found a reference indicating that it is a rare but *NORMAL* variation in fetal heart development. It only shows up in 4% of fetuses but in 12% of fetuses with Trisomy 21. Pretty darn soft marker if you ask me! Either way, nothing much can be done now, just have to wait for Monday :)

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ahhh . . prenatal testing. I've been there. Got preggers at 43 and had my doc encourage all the tests because at my "advanced" age there were increased risks. Had the AFP test which came back positive for Down's . . . .until I did some research and came across a great paper explaining the significance of the test. The only real risk factor was my age for goodness sake. That made it come back positive. . . not any real findings. I had the diagnostic sono, amnio, etc. All for a normal baby. Interesting to find that most Down Syndrom babies are born to young women in their 20's but the risk factor increases as you age. . . . huh? :rolleyes:

We have a group of young people who are mostly Down's Syndrome in our community who live on a real working ranch. They are such a positive influence on our community. Ride horses, raise animals, play basketball in the Special Olympics, live their lives happily. Who the heck says they have less value than a so-called "normal" person?

Best wishes with your pregnancy - don't let em scare ya!!:D

steph

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all is OK - they saw a "possible foci" on the 14w ultrasound which was resolved at the 22w ultrasound :)

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yeah! glad to hear it!

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