case_images: PMC10772415_01
case_images: (A) Gray-scale ultrasound study shows two intrauterine fetuses in a single amniotic cavity, the right twin appears structurally normal-developed with no gross congenital (pump fetus), (arrow). The left twin appears structurally abnormal with no visible cardiac tissue or activity (acardiac fetus). (B) Doppler ultrasound shows two intrauterine fetuses in a single amniotic cavity, the right fetus shows positive regular cardiac activity.
case_images: PJMS-40-242-g001.jpg
case_images: PMC10772415_01_PJMS-40-242-g001.jpg
case_images: F1
case_images: Gray-scale ultrasound imaging showed two intra-uterine fetuses with a single fundo-anterior placenta, and single amniotic cavity (monoamniotic) with heart activity in the first fetus (pump twin) and no visible heart activity in the second fetus (acardiac twin), (Fig.1A). Color and Pulsed Doppler showed pulsating heart in the pump fetus (Fig.1B).
case_images: (A) Ultrasound imaging study shows the gestational age of the pump twin as 27 weeks by biparietal diameter (BPD), and 26 weeks+1 day by femur length (FL), and 27 weeks by abdominal circumference (AC), with about 983 gram expected fetal weight. The pump fetus appears structurally normal with no gross congenital anomalies with no signs of hydrops. (B) Ultrasound imaging study of the acardiac twin which was stuck to the anterior uterine superiorly by amniotic band and shows markedly under-developed upper body organs including upper limbs, upper chest, non-developed head, and non-developed heart, with around 24 weeks gestational age by femur length (FL).
case_images: PJMS-40-242-g002.jpg
case_images: PMC10772415_01_PJMS-40-242-g002.jpg
case_images: F2
case_images: No signs of heart failure or fetal hydrops were noted with average gestational age (GA) of 27 weeks by biparietal diameter (BPD), and abdominal circumference (AC), and 26 weeks+1 day by femur length (FL), with about 983 gram expected fetal weight (Fig.2A). The acardiac twin was stuck to the anterior uterine superiorly by amniotic band and showed markedly under-developed upper body organs including upper limbs, upper chest, non-developed head, and non-developed heart, with around 24 weeks gestational age by FL (Fig.2B), in addition to marked abdominal ascites, and marked edematous changes of the body as signs of fetal hydrops (Fig.3A).
case_images: (A) Ultrasound imaging study of the acardiac twin which was stuck to the anterior uterine superiorly by amniotic band and shows markedly under-developed upper body organs including upper limbs, upper chest, non-developed head, and non-developed fetal heart. In addition to marked ascites, and edematous changes of the fetal body (signs of fetal hydrops), (short arrows), and cyst in the base of the umbilical cord of about 12mm in maximal dimension (long arrow). (B) Ultrasound imaging study shows markedly increased amniotic fluid volume, the largest pocket of approximately 183 mm, and amniotic fluid index (AFI) around 30 cm, indicating marked polyhydramnios.
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case_images: PMC10772415_01_PJMS-40-242-g003.jpg
case_images: F3
case_images: The uterus showed markedly increased amniotic fluid volume, the largest pocket of approximately was 18.3 cm, and the amniotic fluid index (AFI) around 30 cm, indicating marked polyhydramnios (Fig.3B).
case_images: (A) Color Doppler examination shows acardiac twin with short umbilical cord containing only two-vessels (arrows), indicating single umbilical artery, and (B) Ultrasound Doppler examination shows acardiac twin with short umbilical cord containing only two-vessels, indicating single umbilical artery with reverse blood flow.
case_images: PJMS-40-242-g004.jpg
case_images: PMC10772415_01_PJMS-40-242-g004.jpg
case_images: F4
case_images: Color and pulsed Doppler examination showed structurally abnormal acardiac fetus with no heart activity, and short two-vessels of the umbilical cord (Fig.4A) indicating single umbilical artery (Fig.4B), with reversed direction of blood flow seen in iliac blood vessels (Fig.5A).
case_images: (A) Color and spectral Doppler examination shows acardiac twin with reversed direction of vascularity seen in iliac blood vessels. (B) Color and spectral Doppler examination shows anastomotic superficial blood vessels seen crossing the placental surface connecting the short umbilical cord vasculature of the acardiac twin to the pump twin.
case_images: PJMS-40-242-g005.jpg
case_images: PMC10772415_01_PJMS-40-242-g005.jpg
case_images: F5
case_images: Color and pulsed Doppler examination showed structurally abnormal acardiac fetus with no heart activity, and short two-vessels of the umbilical cord (Fig.4A) indicating single umbilical artery (Fig.4B), with reversed direction of blood flow seen in iliac blood vessels (Fig.5A). Anastomotic superficial blood vessels were seen crossing the placental surface connecting the short umbilical cord vasculature of acardiac twin to the pump twin (Fig.5B).