Massive myocardial calcification in second-trimester fetuses: antenatal detection and causes

Massive myocardial calcifications were detected by antenatal ultrasound examination in four second-trimester fetuses. In one fetus, multiple cardiac rhabdomyomas were the initial diagnosis. One fetus presented with arthrogryposis and the brain and spinal cord showed severe hypoxic-ischemic damage. One fetus was hydropic and had severe cardiac malformations. The fourth fetus had congenital heart block and maternal serum was positive for anti-Ro and anti-La antibodies. Myocardial calcifications in the first three fetuses were most likely to be caused by hypoxic-ischemic damage to the heart, and immunological mechanisms were responsible in the other fetus. Antenatally detected myocardial echogenic foci in a fetus leading to a termination of pregnancy or associated with fetal death should be investigated with a full postmortem examination. It is important to confirm the presence of calcifications as distinct from a rhabdomyoma as genetic counseling is completely different. The demonstration of associated lesions in other organs also helps to explain the pathogenesis underlying this condition.