Picture of the Month

A N ECHOCARDIOGRAPHIC examination performed on the fetus of a 23-year-old primigravida woman at 36 weeks’ gestation revealed multiple densities in the right and left ventricles (Figure 1). An earlier fetal echocardiographic examination, performed at 205⁄7 weeks’ gestation, had normal findings. The mother had received prenatal care throughout her pregnancy, which was without complications or known risk factors. Antenatal screening studies were all normal. The mother’s medical history was unremarkable. She took multivitamins and ferrous sulfate regularly and denied ingestion or abuse of alcohol or illicit drugs. Family history was positive for a seizure disorder in a sibling of the mother. There was no family history of fetal death, cardiac or renal diseases, or mental retardation. On physical examination, multiple erythematous papules were noted over the mother’s nose and cheeks (Figure 2). The infant was born at term by spontaneous vaginal delivery. An echocardiographic examination confirmed a structurally normal heart with multiple cardiac tumors within both ventricles (Figure 3). Findings from Holter monitoring were unremarkable without the appearance of arrhythmias. Head and renal ultrasonographic examination results were normal, without evidence of tumors. A complete eye examination by an ophthalmologist and an examination of the infant’s skin revealed no abnormalities.