Twin embolization syndrome

Twin embolization syndrome (TES) is a rare complication of a monozygotic twin pregnancy following an in utero demise of the co-twin.

Pathology

It was traditionally thought to result from the passage of thromboplastic material into the circulation of the surviving twin which causes ischemic structural defects in various organs (particularly the highly vascularized organs such as the central nervous system, gastrointestinal tract, and genitourinary system). An acute hemodynamic shift from live to dead fetus resulting in hypoperfusion is more recently thought to play a role ³.

Associations

There is usually an underlying twin-twin transfusion syndrome as a causative association.

Radiographic features

Antenatal ultrasound

The presence of a dead twin associated with a surviving twin with various anomalies may suggest the diagnosis. Such anomalies include :

CNS anomalies

• fetal ventriculomegaly
• porencephaly
• fetal cerebral atrophy
• cystic encephalomalacia ⁴
• microcephaly

Non-CNS anomalies

• small bowel atresia
• fetal hydrothorax
• gastroschisis
• fetal renal cortical necrosis

Treatment and prognosis

While it carries a poor outcome, prenatal sonographic diagnosis may influence the antenatal neonatal management of the surviving monozygous twin ¹.

See also

• acardiac twin