Ref Number = PITIKA-ASPR0259
Fandi Argiansya, RM. Faisal, Indrayady
Background: Conjoined twins are a rare complication of monozygotic pregnancies. The incidence of conjoined twins is approximately 1:50.000 in utero to 1:250.000 live births. The most common types of conjoined twins were thoraco-omphalopagus (28%), thoracopagus (18.5%), omphalopagus (10%), parasitic twins (10%) and craniopagus (6%). Craniopagus parasiticus is rare with an incidence of approximately four to six cases in 10,000,000 births. In this paper the imaging of craniopagus parasiticus, both antenatally and postnatally is reviewed. 
Case: A male infant was born at 38 weeks of gestation to a 28-year-old G1/P1 by Cesarean section. At 28 weeks of gestation, an ultrasound examination revealed a suspected dicephalic paraphagus conjoined twins. After birth, the boy adapted unwell with a Apgar scores of 6/8/9 also had respiratory distress. For further treatment the baby was transferred to NICU. The birth weight was 4000 gr, length 48 cm, head circumference 28,5 cm and parasitic twin head circumference 48 cm (macrocephaly). In craniopagus parasiticus, a parasitic twin head with an undeveloped or underdeveloped body is conjoined to the head of the developed twin. In our case, the head of the parasitic twin protruded from the temporal area of the normal twin’s cranium. Plain X-ray shows a single trachea, cavum thorax and abdomen. Echocardiography shows Double outlet right ventricle + Nonconcommitant large subaortic ventricular septal defect + Malposition great artery. Head CT Scan shows HIE grade I (normal head), hydrancephali (parasitic head), also had single trachea with two nasopharing and two oropharyng. Vascular connections can be delineated by CT angiography which helps in planning of proper surgical procedure. 
Conclusion: Sonography and MRI plays a significant role in diagnosis and delivery planning of conjoined twins in prenatal period. Postnatally plain X-Ray, echocardiography, CT, angiography provides excellent anatomic details, clearly delineating the level and nature of connection between the twins, and helps in proper surgical planning.
Keywords: Conjoined Twins, Craniopagus Parasiticus, Radiology
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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