Utility of Fetal Magnetic Resonance Imaging After Ultrasound in Differentiating Dicephalic Dibrachius Dipus Twin Gestation From Craniopagus Parasiticus

Harneet S Randhawa,Jasneet Randhawa,Akshay More,Akshay Jain

doi:10.7759/cureus.19444

Abstract

Conjoined twins represent a very rare congenital anomaly, and the dicephalic dibrachius dipus (DDD) type of conjoined twinning is so rare that the exact prevalence is unknown. Only a few published case studies have mentioned this anomaly. Not enough data are available where antenatal ultrasonography (USG) and MRI have been employed in the workup of such cases. This study describes the case of a 24-year-old woman who came to our department for an anomaly scan at 25 weeks of gestation and was diagnosed with a dicephalic type of conjoined twinning with multiple anomalies. However, USG could not differentiate between DDD twinning and craniopagus parasiticus; hence, the patient was referred for fetal MRI. On MRI, the diagnosis of DDD was confirmed. In craniopagus parasiticus twinning, the surgical removal of the parasitic head can allow an everyday life. However, DDD twinning with multiple anomalies is not compatible with life, and the mother was thoroughly explained the grave prognosis. In such doubtful cases, fetal MRI should always be employed to ascertain the diagnosis for proper management and counseling.

Highlights

Conjoined twinning is an abnormal type of twinning that occurs in monochorionic gestations
Conjoined twins represent a very rare congenital anomaly, and the dicephalic dibrachius dipus (DDD) type of conjoined twinning is so rare that the exact prevalence is unknown
This study describes the case of a 24-year-old woman who came to our department for an anomaly scan at 25 weeks of gestation and was diagnosed with a dicephalic type of conjoined twinning with multiple anomalies

Summary

Introduction

Conjoined twinning is an abnormal type of twinning that occurs in monochorionic gestations. In this anomaly, some part of the twins is joined. Conjoined twins have an incidence of 1 in 50,000 to 1 in 100,000 gestations. Conjoined twins are often associated with multiple congenital anomalies, and a large percentage die in utero, resulting in an incidence of 1 in 250,000 live births [1]. DDD twinning is one of the rarest types, with only a few documented cases worldwide. In this type of twinning, there are two heads, one trunk, two arms, and two legs. The exact incidence of this anomaly has not been documented [3]

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