International Journal of Infertility & Fetal Medicine

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VOLUME 14 , ISSUE 3 ( September-December, 2023 ) > List of Articles


Diprosopus Tetraophthalmus with Double Outlet Right Ventricle, Congenital Diaphragmatic Hernia, and Duplicated Gall Bladder on Targeted Antenatal Ultrasound with Postnatal Ultrasound and Computed Tomography Correlation

Juvaina Puthiyakam, S Rubalakshmi, Ellezhuthil Devarajan, N Priya, George Pappachan

Keywords : Antenatal, Case report, Diprosopus, Fetal magnetic resonance imaging, Parapagus, Postnatal computed tomography, Tetraophthalmus, Ultrasound

Citation Information : Puthiyakam J, Rubalakshmi S, Devarajan E, Priya N, Pappachan G. Diprosopus Tetraophthalmus with Double Outlet Right Ventricle, Congenital Diaphragmatic Hernia, and Duplicated Gall Bladder on Targeted Antenatal Ultrasound with Postnatal Ultrasound and Computed Tomography Correlation. Int J Infertil Fetal Med 2023; 14 (3):148-153.

DOI: 10.5005/jp-journals-10016-1323

License: CC BY-NC 4.0

Published Online: 28-11-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Aim: Diprosopus is the rarest form of conjoined twinning, and hence this case is evaluated in detail with multimodality imaging both antenatally and postnatally. Background: Diprosopus is a Greek word meaning “two faces.” It is also known as craniofacial duplication. These patients will have two faces with a single thorax and abdominopelvic cavity. The number of limbs may vary from 4 to 7. They are frequently associated with other congenital anomalies of the central nervous, gastrointestinal, cardiovascular, and respiratory systems. Case description: We are presenting a case of 26-year-old primi conceived by intracytoplasmic sperm injection (ICSI). Targeted imaging for fetal anomalies (TIFFA) scan showed complete duplication of facial structures, cerebral hemispheres, the thalami and midbrain, and a large posterior fossa. Other associated anomalies included a hypoplastic left heart with a double outlet right ventricle, a congenital diaphragmatic hernia on the left side, and a duplicated gall bladder. The fetus had a single trunk and abdomen with two upper limbs and two lower limbs. Prenatal fetal magnetic resonance imaging (MRI) confirmed the findings. The poor prognosis was explained to the parents and they decided on medical termination of pregnancy. Postnatal fetal examination and multimodality imaging [X-ray, ultrasonography (USG), and computed tomography (CT)] were performed which correlated with the antenatal diagnosis and helped to understand and delineate the anatomy better. Conclusion: Detailed prenatal USG imaging helps in identifying most of the anomalies which can be confirmed by fetal MRI. Postnatal CT with the three-dimensional (3D) reconstruction aids in definite diagnosis in selected patients. Clinical significance: A high index of suspicion is required to diagnose diprosopus in an anomaly scan. Since it is associated with multiple anomalies of other systems, the radiologist/sonologist should thoroughly search for the same. The supplementary use of fetal MRI helps to confirm the diagnosis. Postnatal CT with 3D reconstruction aids in better comprehension of the anomalies.

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