Baboo, Shyam

Hashmi, M A

English

Atharva Scientific Publications (E-Jounals)

Vol 4 | Issue 1 | Jan - Feb 2018 Indian J Case Reports 80
Images in Clinical Practice
Heteropagus conjoined twin - magnetic resonance imaging finding and its 
importance
Shyam Baboo1, M A Hashmi2
From 1Departments of  Radiology, Sri Krishna Medical College, Muzaffarpur, Bihar, 2EKO-Medical College and Hospital, Kolkata, West Bengal, India
Correspondence to: M A Hashmi, EKO-Medical College and Hospital, Kolkata, West Bengal, India. Mobile: +91-9830202481. 
E-mail: ahashmidrrad@yahoo.co.in
Received - 06 January 2018 Initial Review - 31 January 2018 Published Online - 08 March 2018
Conjoined twin is a rarely seen congenital anomaly and is one of the rarest forms of twinning which occurs in monozygotic twins without genetic 
predisposition. Ultrasonography (USG) is the gold 
standard method for imaging of above condition and it also 
helps in further treatment planning. The use of magnetic 
resonance imaging (MRI) with multiplanar imaging and 
without any radiation is extremely helpful for managing 
such disorder [1]. Heteropagus twinning is a rare form of 
above disorder in which one of the fetuses is not completely 
formed.
A 3-day-old child presented to our department for MRI imaging 
from pediatric surgery department (Fig. 1). On examination of the 
conjoined twin, the fusion was found at the thoracoabdominal region. 
One of the children (among conjoined twin) was having normal head 
and thoracic region. The parasite (the dependent fetus) was attached 
Figure 1: The parasite (the dependent fetus) was attached to upper 
abdominal wall and its limbs were visible
Figure 2: T2 axial magnetic resonance imaging image is showing the 
dependent fetus with its limb attach to abdominal wall
Figure 3: Bowel loops were seen communicating on both the sides 
with blood vessel signals were also there
Figure 4: Communication was at epigastric level and no such 
communication was noted at thoracic level
Baboo and Hashmi Heteropagus conjoined twin
Vol 4 | Issue 1 | Jan - Feb 2018 Indian J Case Reports 81
to upper abdominal wall of normal looking fetus, and its limbs were 
only visible. Its head and thoracic cavity were not formed (Fig. 2). 
Bowel loops were seen communicating on both the side in fetus and 
in parasite and blood vessel signals were also there (Fig. 3). MRI 
revealed that the communication was at epigastric level and no such 
communication was noted at thoracic level (Fig. 4). After the findings 
of MRI, surgical management was decided for the above condition.
Conjoined twins are rare condition of unknown etiology. 
Incomplete division of embryonic disc within 13 days of 
fertilization is considered to be the etiology factor. Conjoined 
twins can be classified as symmetric or asymmetric type. 
Symmetrical type is the fusion of two identical twins at a certain 
site on both sides. This may be fusion at chest (thoracopagus), 
fusion at anterior abdominal wall (omphalopagus) at pelvis/
ischium (ischiopagus), at cranium (craniopagus), or a combination 
of above condition [2]. Asymmetrical twins are also called as 
parasitic twins or heteropagus in which the dependent fetus or 
parasite is not completely formed and is attached to the normally 
formed fetus with evident of supernumerary limbs [3]. Depending 
on the site of union and extent of damage, it can be parasitic twin, 
enclosed fetus-in-fetu, internal teratoma, or cardiac variety. The 
parasitic variety usually does not have functional brain or heart 
with rudimentary gastrointestinal tract or urinary tract which 
can be seen as communication between the two in imaging 
procedures. These cases of parasitic variety of conjoined twins 
can be separated by the use of surgical procedures.
Diagnosis and management of conjoined twins is very 
difficult. The use of USG and MRI can be a great help in planning 
and management of such conditions. Among these two, making 
an early diagnosis with MRI can predict accurately the site of 
union (at thoracic or brain level) of heteropagus twins.
REFERENCES
1. Singh Y, Kathpalia SK, Bal H, Arif NK. Early prenatal diagnosis in a case of 
conjoined twin with craniopagus and thoraco-omphalopagus. Med J Armed 
Forces India 2012;68:381-2.
2. Katke RD. A rare presentation of heteropagus conjoined twin: A case 
report with review of literature. Int J Reprod Contracept Obstet Gynecol 
2015;4:851-4.
3. Chen P, Choe KA. Prenatal MRI of heteropagus Twins. Am J Roentgenol 
2003;181:1676-8.
Funding: None; Conflict of Interest: None Stated.
How to cite this article: Baboo S, Hashmi MA. Heteropagus conjoined 
twin - magnetic resonance imaging finding and its importance. Indian J Case 
Reports. 2018;4(1):80-81.


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Heteropagus conjoined twin - magnetic resonance imaging finding and its importance

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