During the 20-week scan, a small bright spot is sometimes seen inside your baby's heart. This is called an echogenic focus in the heart, sometimes described as a "golf ball" or "bright spot" in the heart.
It is natural to feel worried when told about any finding on your baby's scan. The good news is that an echogenic focus on its own is very common, does not affect how your baby's heart works, and in most pregnancies is considered a normal variation.
Key points
- An echogenic focus in the heart is a small bright spot seen in the baby's heart on ultrasound.
- It is common and is seen in many healthy babies.
- It is not a heart defect and does not affect how the heart works.
- When it is the only finding, it makes little or no difference to the chance of Down's syndrome.
- After a low-risk NIPT or combined screening result, an isolated echogenic focus needs no further tests, scans or checks after birth.
- If you have not had screening, we can discuss your options, such as NIPT.
What is an echogenic focus in the heart?
An echogenic focus in the heart is a small, bright spot seen within one of the chambers of the baby's heart during an ultrasound scan. "Echogenic" means that it reflects the ultrasound strongly, so it looks bright on the screen, about as bright as bone.
The spot is thought to be a tiny area of extra calcium in the muscle or in the small "strings" that support the heart valves. It is most often seen in the left side of the heart (the left ventricle). Occasionally, it is seen on the right side or on both sides.
Does it mean my baby has a heart problem?
No. An echogenic focus is not a structural heart defect, and it does not affect the way your baby's heart develops or works. It does not cause any symptoms, and it does not need any treatment, either during pregnancy or after birth.
When an echogenic focus is seen, we carefully examine the rest of your baby's heart, including its chambers, valves and major blood vessels, as part of our detailed 20-week scan. If the heart otherwise looks normal, a separate specialist heart scan (fetal echocardiogram) is not needed just because of an echogenic focus.
Does it matter if there is more than one bright spot?
A 2024 systematic review of 19 studies concluded that multiple isolated echogenic foci did not carry a higher risk than a single echogenic focus. It found no justification for routine follow-up of isolated left-sided echogenic foci.
Is an echogenic focus a sign of Down's syndrome?
In the past, an echogenic focus was considered a "soft marker" for Down's syndrome, because it is seen a little more often in babies with the condition. However, a large review of 48 studies found that when an echogenic focus is the only finding and the rest of the scan is normal, it makes virtually no difference to the chance of Down's syndrome.
In practical terms, this means that your chance of Down's syndrome stays about the same as it was before the scan. For example, if your chance was 1 in 1,000 before the scan, it remains about 1 in 1,000 afterwards.
For further information, read: Genetic Markers and Soft Markers at the 20-Week Scan: What Do They Mean?
What if I have already had low-risk screening?
If you have had a low-risk result from NIPT or combined screening, and the echogenic focus is the only finding, it is considered a normal variant of no clinical importance. International guidance recommends:
- No further genetic tests, such as amniocentesis.
- No specialist fetal heart scan.
- No extra follow-up scans because of the echogenic focus.
- No tests for your baby after birth.
You can continue your pregnancy care as normal.
What if I have not had any screening?
If you have not had screening for Down's syndrome earlier in pregnancy, we will explain what an isolated echogenic focus means for you and discuss your options. Because an echogenic focus on its own has very little effect on the chance of Down's syndrome, many parents choose not to have further tests. If you would like more reassurance, a non-invasive prenatal test (NIPT), which is a simple blood test from you, is usually the most appropriate next step. An invasive test such as amniocentesis is not usually recommended because of an isolated echogenic focus alone.
What if other findings are seen?
An echogenic focus is only considered reassuring when it is an isolated finding. If other markers or structural differences are seen on the scan, the overall picture needs to be considered more carefully. In this situation, we will discuss the findings with you in detail and explain whether further tests, such as NIPT or amniocentesis, may be helpful.
Will the bright spot go away?
An echogenic focus may still be seen on later scans, or it may become less obvious as your baby grows. Either way, it does not matter: whether or not it is still visible makes no difference to your baby's health, and it does not need to be checked again.
How does The Pregnancy Clinic assess an echogenic focus in the heart?
As part of our detailed consultant-led 20–22-week scan, we:
- Examine your baby's heart in detail, including its chambers, valves and major blood vessels.
- Check the rest of your baby's anatomy, to confirm whether the echogenic focus is an isolated finding.
- Review your earlier screening results, such as combined screening or NIPT.
- Explain clearly what the finding means for you and your baby, and whether any further tests would be helpful.
Our aim is to give you accurate, reassuring information and to avoid unnecessary worry or tests.
Related pregnancy guides
Frequently asked questions
What is an echogenic focus in the heart?
It is a small bright spot seen in the baby's heart on ultrasound, thought to be a tiny area of extra calcium. It is common and is usually a normal variation.
Is an echogenic focus a heart defect?
No. It does not affect how the baby's heart develops or works, and it does not need treatment during pregnancy or after birth.
Does an echogenic focus mean my baby has Down's syndrome?
On its own, an echogenic focus makes virtually no difference to the chance of Down's syndrome. Your chance stays about the same as it was before the scan.
I had a low-risk NIPT. Do I need more tests?
No. After a low-risk NIPT or combined screening result, an isolated echogenic focus needs no further genetic tests, heart scans, follow-up scans or checks after birth.
Will the bright spot disappear?
It may still be seen on later scans or become less obvious. Either way, it makes no difference to your baby's health.
Book your detailed 20-week scan at The Pregnancy Clinic
At The Pregnancy Clinic, our consultant-led 20–22-week examinations include a detailed assessment of your baby's heart and anatomy, and of any soft markers, interpreted alongside your previous screening results.
If you have been told that your baby has an echogenic focus in the heart, we can provide a detailed specialist assessment and explain clearly what it means for your pregnancy.
Book your detailed 20-week scan →This article provides general educational information and does not replace personalised medical advice. The Pregnancy Clinic provides planned appointments only; for urgent concerns, please contact your maternity unit, NHS 111 or your GP.
Clinical references
- Agathokleous M, Chaveeva P, Poon LCY, Kosinski P, Nicolaides KH. Meta-analysis of second-trimester markers for trisomy 21. Ultrasound Obstet Gynecol. 2013;41(3):247–261.
- Society for Maternal-Fetal Medicine. Consult Series #57: Evaluation and management of isolated soft ultrasound markers for aneuploidy in the second trimester. Am J Obstet Gynecol. 2021;225(4):B2–B15.
- Salomon LJ, et al. ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound Obstet Gynecol. 2022;59:840–856.
- NHS. Screening for Down's syndrome, Edwards' syndrome and Patau's syndrome.
- Jones HE, Battaglia S, Hurt L, Uzun O, Brophy S. Echogenic intracardiac foci detection and location in the second-trimester ultrasound and association with fetal outcomes: a systematic literature review. PLoS One. 2024;19(4):e0298365.