left ventricle – echogenic focus
description
this is an echogenicity of the papillary muscles of the mitral valve due to excess calcium deposition in this site and has been termed a golf ball. it is a common normal variant but also occurs with increased frequency in down syndrome and should be seen as a soft sign of a chromosomal defect. if there are multiple golf balls and they occur in both ventricles, there is an increased association with trisomies 13, 18 and 21. karyotyping should be recommended if there are any other malformations or in an older mother. this lesion has no cardiac significance.
diagnosis
a golf ball appears as a bright spot in the left ventricular myocardium. it does not cause any functional disturbance to the mitral valve apparatus. it is most frequent in the lateral papillary muscle but it can occur in the septum or in the right heart. with the caveat of excluding a chromosomal anomaly, it is a benign finding which is much less prominent after birth and is not associated with clinical signs.
differential diagnosis
a benign echogenic focus should be distinguished from linear calcification of both papillary muscles which occurs as a common feature of critical aortic stenosis in the fetus. in this setting the aortic and mitral valve function will be abnormal. a golf ball has been mistaken for a rhabdomyoma but this lesion tends to be less echogenic and larger in size. in addition, rhabdomyomas are usually multiple and scattered throughout the heart and not in the typical position of the left ventricular echogenic focus.
sonographic features
bright spot usually in lv free wall papillary muscles
may be multiple, in lv cavity or rv.
no cardiac abnormality.
associated syndromes
references
allan ld, sharland g, cook a in: colour atlas of fetal cardiology mosby-wolfe: london. p28
petrikovsky bm, challenger m, wyse lj natural history of echogenic foci within ventricles of the fetal heart ultrasound obstet gynecol 5:92-4
benacerraf, br the second-trimester fetus with down syndrome: detection using sonographic features ultrasound obstet gynecol 7:147-155
brown dl, roberts dj, miller wa left ventricular echogenic focus in the fetal heart, pathologic correlation j ultrasound med 13: 613-616
lehman cd, nyberg da, winter tc iii, kapur ap, et al trisomy 13 syndrome, prenatal us findings in a review of 33 cases radiology 194: 217-22
roberts dj, genest d cardiac histologic pathology characteristic of trsomies 13 and 21 hum pathol 23: 1130-40
bromley b, lieberman e, laboda la, benacerraf br echogenic intracardiac focus, a sonographic sign for down syndrome? obstet gynecol 86: 998-1001