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Case series: TRAP sequence.

Chandramouly M - Indian J Radiol Imaging (2009)

Bottom Line: TRAP (twin reversed arterial perfusion) sequence / acardiac twinning is a rare anomaly that occurs in monozygotic monochorionic twins with an incidence of 1% and in 1 in 35,000 pregnancies overall.The anomalous twin appears as a heterogeneous mass, simulating a teratoma or intrauterine fetal demise.As the normal twin faces increased morbidity and mortality, antenatal diagnosis with gray-scale examination, and Doppler confirmation of the diagnosis of TRAP sequence in twin pregnancies, aids in proper prenatal management.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, RAGAVS Diagnostic and Research Centre Pvt Ltd., Sadguru Complex, No.14, 27th Cross, 4th Block West, Jayanagar, Bangalore - 560 011, India.

ABSTRACT
TRAP (twin reversed arterial perfusion) sequence / acardiac twinning is a rare anomaly that occurs in monozygotic monochorionic twins with an incidence of 1% and in 1 in 35,000 pregnancies overall. The anomalous twin appears as a heterogeneous mass, simulating a teratoma or intrauterine fetal demise. As the normal twin faces increased morbidity and mortality, antenatal diagnosis with gray-scale examination, and Doppler confirmation of the diagnosis of TRAP sequence in twin pregnancies, aids in proper prenatal management. We report two cases of TRAP sequence that we encountered over a single month, with the two cases having different outcomes.

No MeSH data available.


Related in: MedlinePlus

Case 1: Transabdominal USG shows a monochorionic monoamniotic twin gestation with a normal fetus (arrow) and the circular abdominal stump of the abnormal fetus demonstrating heterogeneous echotexture, without any discernable internal organs (arrowhead)
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Figure 0001: Case 1: Transabdominal USG shows a monochorionic monoamniotic twin gestation with a normal fetus (arrow) and the circular abdominal stump of the abnormal fetus demonstrating heterogeneous echotexture, without any discernable internal organs (arrowhead)

Mentions: A 29-year-old lady, G4P0L0A3, came for a second trimester anomaly scan. USG revealed a monochorionic, monoamniotic twin gestation with one normal appearing fetus of gestational age 22–23 weeks [Figure 1]. The patient also had polyhydramnios and a single large placental mass located in the fundo-anterior region [Figure 1]. The second fetus had an incompletely formed skeleton, with no head, upper limbs, heart, or thoracic structures. It had an abdominal stump without any intraabdominal organs; there were two well-developed lower limbs which showed massive, diffuse, soft tissue edema [Figure 2]. On color Doppler imaging, the umbilical artery in the abnormal fetus showed reversal of flow on the spectral graph [Figure 3]. The umbilical cord of the abnormal fetus had only a single umbilical artery. This appearance was typical of a TRAP sequence with an acardiac parabiotic twin (acardius acephalus / acardius chorioangiopagus parasiticus). This patient went into premature labor secondary to polyhydramnios at 27 weeks of gestation and delivered an amorphous mass and a normal-appearing fetus which, however, died soon thereafter.


Case series: TRAP sequence.

Chandramouly M - Indian J Radiol Imaging (2009)

Case 1: Transabdominal USG shows a monochorionic monoamniotic twin gestation with a normal fetus (arrow) and the circular abdominal stump of the abnormal fetus demonstrating heterogeneous echotexture, without any discernable internal organs (arrowhead)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2747410&req=5

Figure 0001: Case 1: Transabdominal USG shows a monochorionic monoamniotic twin gestation with a normal fetus (arrow) and the circular abdominal stump of the abnormal fetus demonstrating heterogeneous echotexture, without any discernable internal organs (arrowhead)
Mentions: A 29-year-old lady, G4P0L0A3, came for a second trimester anomaly scan. USG revealed a monochorionic, monoamniotic twin gestation with one normal appearing fetus of gestational age 22–23 weeks [Figure 1]. The patient also had polyhydramnios and a single large placental mass located in the fundo-anterior region [Figure 1]. The second fetus had an incompletely formed skeleton, with no head, upper limbs, heart, or thoracic structures. It had an abdominal stump without any intraabdominal organs; there were two well-developed lower limbs which showed massive, diffuse, soft tissue edema [Figure 2]. On color Doppler imaging, the umbilical artery in the abnormal fetus showed reversal of flow on the spectral graph [Figure 3]. The umbilical cord of the abnormal fetus had only a single umbilical artery. This appearance was typical of a TRAP sequence with an acardiac parabiotic twin (acardius acephalus / acardius chorioangiopagus parasiticus). This patient went into premature labor secondary to polyhydramnios at 27 weeks of gestation and delivered an amorphous mass and a normal-appearing fetus which, however, died soon thereafter.

Bottom Line: TRAP (twin reversed arterial perfusion) sequence / acardiac twinning is a rare anomaly that occurs in monozygotic monochorionic twins with an incidence of 1% and in 1 in 35,000 pregnancies overall.The anomalous twin appears as a heterogeneous mass, simulating a teratoma or intrauterine fetal demise.As the normal twin faces increased morbidity and mortality, antenatal diagnosis with gray-scale examination, and Doppler confirmation of the diagnosis of TRAP sequence in twin pregnancies, aids in proper prenatal management.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiodiagnosis, RAGAVS Diagnostic and Research Centre Pvt Ltd., Sadguru Complex, No.14, 27th Cross, 4th Block West, Jayanagar, Bangalore - 560 011, India.

ABSTRACT
TRAP (twin reversed arterial perfusion) sequence / acardiac twinning is a rare anomaly that occurs in monozygotic monochorionic twins with an incidence of 1% and in 1 in 35,000 pregnancies overall. The anomalous twin appears as a heterogeneous mass, simulating a teratoma or intrauterine fetal demise. As the normal twin faces increased morbidity and mortality, antenatal diagnosis with gray-scale examination, and Doppler confirmation of the diagnosis of TRAP sequence in twin pregnancies, aids in proper prenatal management. We report two cases of TRAP sequence that we encountered over a single month, with the two cases having different outcomes.

No MeSH data available.


Related in: MedlinePlus