Golf ball phenomenon

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The golf ball phenomenon ( Engl. Also white spots ) describes individually or grouped occurring punctate densities in the right, but more often in the left big heart chamber (ventricle) or both ventricles of an unborn child, often in fine ultrasound as hyperechoic areas, as so-called intracardiac echogenic focus (Singular) or as echogenic intracardiac foci (plural). Because white spots are visible as round, white dots, they have been called golf balls .

Echo-rich or echogenic means that an organ , tissue or structure appears bright on an ultrasound image , intracardial means that there is a special feature within the heart , and focus denotes a centering in the sense of a clearly delimited area.

Whether and, if so, how clearly white spots can be shown in the ultrasound depends on the contrast setting and the overall gain of the examination device. Their echogenicity is comparable to that of the child's bones; the echo density of a vertebral body can apply as the limit value.

Emergence

How white spots are created is not yet sufficiently known. Some scientists believe that these are places where the heart tissue , especially the papillary muscles (muscles that connect the leaflet valves with the ventricular muscles and hold the heart valves during the systolic heartbeat ) and the chordae tendineae ( tendon threads covered by the endocardium between the papillary muscles and the valve leaflets; therefore the term echogenic chordae tendineae is used as a synonym for white spots ) has not yet been fully developed. Others believe that it is small calcifications ( micro- calcifications ) or salt deposits.

Frequency and importance

White spots occur in around 2 to 4.7% of all babies in the second trimester of pregnancy and usually resolve spontaneously. Because of this, in percentage terms, they are found more frequently before the 20th week of pregnancy than in the period after.

If white spots appear in isolation, i.e. without any further (physical) peculiarities, in most cases they are merely harmless phenomena without functional significance, which regress on their own and are not dangerous or harmful to the physical and cognitive development and health of the growing child are.

If, on the other hand, white spots appear in combination, i.e. in connection with certain other (physical) peculiarities, they are considered an indication ( soft marker ) of a chromosome peculiarity, for example Down syndrome (trisomy 21), the Patau syndrome (trisomy 13) or a trisomy 9 in the unborn child. The association for Down syndrome seems to be given in particular when white spots can be seen in the right ventricle and / or complex echogenic foci are present in the heart. The increase in the probability of chromosomal peculiarities calculated from the presence of one or more white spots is, however, quite small, so that it is not undisputed whether or not white spots can actually be regarded as soft markers: while some of the studies carried out so far show a slight percentage increase in the probability could confirm, other studies did not find any evidence of a percentage increase in the probability of chromosomal peculiarities in the unborn child due to white spots .

Procedure after the assessment

White spots are not heart defects (cardiac vitia). In order to clarify any physical peculiarities that may exist, a detailed organ diagnosis with echocardiography of the child's heart is recommended after the detection of white spots .

Invasive examinations (such as chorionic villus sampling or amniocentesis ) should not be performed solely on the basis of white spots due to the associated risks (including miscarriage ) . If ultrasound examinations reveal further physical characteristics that indicate a chromosomal peculiarity, invasive diagnostics for karyotyping can be considered, which should be preceded by detailed advice on the risks and possible consequences.

Other "golf ball phenomena"

There are two other peculiarities that are also referred to in medicine as the golf ball phenomenon :

literature

  • Anne-Sybil Gast, Monika Schießer, Christof Sohn: Checklist Sonography in Gynecology and Obstetrics , Georg Thieme Verlag, 2001 ( p. 133 )
  • Christof Sohn: Ultrasound in Gynecology and Obstetrics , Georg Thieme Verlag, 2003 ( p. 375 )
  • Anke Reitter, Rolf Schlösser: Perinatal medicine in cases: prenatal diagnostics, management and advice , Georg Thieme Verlag, 2008 ( p. 65 )

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