case_images: PMC4374195_01
case_images: 22-year-old pregnant asymptomatic female who came for routine antenatal checkup, diagnosed with twin reversed arterial perfusion (TRAP) sequence pregnancy. (a) Transabdominal ultrasonography and (b) color flow US images reveal monochorionic, diamniotic twin gestation with a normal fetus showing heart (arrows) and the abnormal fetus showing umbilical cord (arrowheads) with a single placenta (curved arrow).
case_images: JCIS-5-9-g002.jpg
case_images: PMC4374195_01_JCIS-5-9-g002.jpg
case_images: F1
case_images: Later she was referred to the Department of Radiology, and the ultrasound images showed twin monochorionic, diamniotic intra-uterine pregnancy with a viable, normal-appearing first twin and amorphous structured second twin [Figure 1]. The placenta was located in the left lateral region of the upper uterine segment [Figure 1].
case_images: 22-year-old pregnant asymptomatic female who came for routine antenatal checkup, diagnosed with twin reversed arterial perfusion (TRAP) sequence pregnancy. Transabdominal ultrasonography scans (a) oblique and (b) axial views of abnormal fetus show well-developed lower limbs (curved arrow in a) with feet and umbilical cord (arrow in b), and diffuse, gross soft tissue edema (arrowheads).
case_images: JCIS-5-9-g003.jpg
case_images: PMC4374195_01_JCIS-5-9-g003.jpg
case_images: F2
case_images: There was gross, diffuse soft tissue edema in the second twin [Figure 2].
case_images: 22-year-old pregnant asymptomatic female who came for routine antenatal checkup, diagnosed with twin reversed arterial perfusion (TRAP) sequence pregnancy. Pulsed Doppler ultrasound of the umbilical cord of the abnormal fetus shows flow reversal on the spectral pattern.
case_images: JCIS-5-9-g004.jpg
case_images: PMC4374195_01_JCIS-5-9-g004.jpg
case_images: F3
case_images: Umbilical cord was seen entering the second twin with intact blood flow and pulsed Doppler study revealed reversal of the flow on the spectral pattern [Figure 3].
case_images: 22-year-old pregnant asymptomatic female who came for routine antenatal checkup, diagnosed with twin reversed arterial perfusion (TRAP) sequence pregnancy. (a and b) Magnetic Resonance Imaging T2-weighted coronal images of abdomen for fetal assessment show normal fetus (arrowheads) in cephalic presentation, with abnormal fetus demonstrating lower limbs with feet (arrows); absent head, upper limbs, thorax; and a single placenta (curved arrow) in the left lateral region of the upper uterine segment.
case_images: JCIS-5-9-g005.jpg
case_images: PMC4374195_01_JCIS-5-9-g005.jpg
case_images: F4
case_images: Also, a single placenta located in the left lateral region of the upper uterine segment was confirmed on Magnetic resonance imaging [Figure 4].
case_images: 22-year-old pregnant asymptomatic female who came for routine antenatal checkup, diagnosed with twin reversed arterial perfusion (TRAP) sequence pregnancy. (a and b) Post delivery day 1 photos of the acardius acephalus twin show the fetus with a single placenta (arrows) and two umbilical cords with grossly edematous, malformed fetus (curved arrows) showing tuft of coarse and lusterless hair in the midline at supraumbilical region (arrowhead).
case_images: JCIS-5-9-g006.jpg
case_images: PMC4374195_01_JCIS-5-9-g006.jpg
case_images: F5
case_images: The acardius acephalus fetus was grossly edematous and showed tuft of coarse and lusterless hair in the midline at supraumbilical region [Figure 5].
case_images: 22-year-old pregnant asymptomatic female who came for routine antenatal checkup, diagnosed with twin reversed arterial perfusion (TRAP) sequence pregnancy. Postoperative day 1 plain X-ray (infantogram) of acardius acephalus twin shows normal lower limb bones, pelvic bone, lower vertebrae, last four paired ribs (curved arrow) with absence of cephalic structures (head, heart, upper limbs, and thorax), and a single placenta (arrowhead).
case_images: JCIS-5-9-g007.jpg
case_images: PMC4374195_01_JCIS-5-9-g007.jpg
case_images: F6
case_images: Plain X-ray of the acardius acephalus fetus revealed normal lower limb bones, pelvic bone, lower vertebrae with the last four paired ribs, and an abrupt ending of bones above it confirming the absence of cephalic structures (i.e. head, heart, upper limbs, and thorax) [Figure 6].