Acardiac twin

Case contributed by Dr Ashraf Ali Mohammad Mahran


The pregnant lady comes to the radiological clinic to assess the living fetus (she knew that only one of her twin pregnancy is alive).

Patient Data

Age: 30 years
Gender: Female

The uterus shows 2 gestational sacs (upper & lower): The upper gestational sac shows large tissue of unrecognizable structures, no cardiac tissue seen within (acardiac).

The lower gestational sac shows alive fetus with severe oligohydramnios.

Case Discussion

The patient suffers from secondary infertility and received 2 doses of ovarian stimulants injections. She was subsequently referred from the obstetric clinic to the radiology center for an assessment the fetal viability and was informed that only one of the twin is alive.

The dead fetus in the other gestational sac shows no recognizable structures (i.e. amorphous tissue). No heart seen within these tissues. The main differential diagnosis is "TRAP syndrome" where there will be an arterial anastomosis through the placenta, so that the acardiac fetus will receive the blood from the alive fetus (pump fetus). 

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