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1999-06-02-18 Twin embolization syndrome © Silva  www.thefetus.net/


Twin embolization syndrome

Sandra Rejane Silva, MD2, Luís Flávio de Andrade Gonçalves, MD1, Philippe Jeanty, MD, PhD3

[1] Florianopolis, SC Brazil lufla@netco.com.br , [2] Sao Paulo – SP docsilva@apm.org.br [3] Nashville, TN jeanty@pov.net

Adapted and reproduced with permission from TKI Medcon Inc. http:/www.tki.com/

Definition

Twin embolization syndrome is a complication of monozygotic twinning following in utero demise of the co-twin. It results from the embolization of placentary and fetal thromboplastins or to the direct embolization of necrosed fragments of the placenta from the dead fetus, disseminated intravascular coagulation causing embolization, or even an infectious endarteritis.

The emboli damage predominantly highly vascular organs such as the brain and kidneys, but can affect almost all organ systems. In the central nervous system these emboli can result in ventriculomegaly, porencephaly, cerebral atrophy, cystic encephalomalacia or microcephaly

Extracranial abnormalities include small bowel atresia, gastroschisis, hydrothorax, aplasia cutis and renal cortical necrosis

Sonographic features

Dead twin associated with a surviving twin with:

    • CNS anomalies
    • ventriculomegaly,
    • porencephaly,
    • cerebral atrophy,
    • cystic encephalomalacia
    • microcephaly
    • Somatic anomalies
    • small bowel atresia,
    • gastroschisis,
    • hydrothorax,
    • aplasia cutis
    • renal cortical necrosis

Image50.jpg (8354 bytes)

Cystic encephalomalacia in the surviving of a stuck twin syndrome

Differential diagnosis

The presence of any of the above mentioned anomalies in the surviving twin with a dead co-twin should raise the suspicion.

Associated syndromes

Twin-to-twin transfusion (cause)

Reference

    • Caballero P, Del Campo L, Ocon E Cystic encephalomalacia in twin embolization syndrome. Radiology 1991 Mar;178(3):892-893
    • Patten RM, Mack LA, Nyberg DA, Filly RA Twin embolization syndrome: prenatal sonographic detection and significance. Radiology 1989 Dec;173(3):685-689
    • Dallay D, Soumireu-Mourat J Problems posed by the death of one fetus in a twin pregnancy. Rev Fr Gynecol Obstet 1985 Dec;80(12):877-879
    • Rolland M, Sevely A, Pradere M, Manelfe C, Regnier C. Antenatal cerebral artery occlusions. Pediatrie 1983 Apr;38(3):151-160
    • Bryan EM. The intrauterine hazards of twins. Arch Dis Child 1986 Nov;61(11):1044-1045
    • Fuentes A, Porter KB, Torres BA, Saadeh S, Duesenberg K, O"Brien WF A twin gestation complicated by gastroschisis in both twins. J Clin Ultrasound 1996 Jan;24(1):48-50
    • Yancey MK, Brady K, Read JA Sonographic evidence of fetal hydrothorax after in-utero death of monozygotic twin. J Clin Ultrasound 1991 Mar;19(3):162-166
    • Van den Veyver IB, Schatteman E, Vanderheyden JS, Van Wiemeersch J, Meulyzer P: Antenatal fetal death in twin pregnancies: a dangerous condition mainly for the surviving Eur J Obstet Gynecol Reprod Biol 1991 Jan 4;38(1):69-73
    • Riehn A Risk following intrauterine death of one of the fetuses in twin pregnancy. Zentralbl Gynakol 1982;104(23):1530-1536
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