Diagnostic dilemma in a neglected case of fetus-in-fetu solved with Magnetic Resonance Imaging and MDCT - a case report and review of literature

Abstract

Fetus-in-fetu (FIF) is a rare anomaly in which a vertebrate fetus is enclosed within the body of its twin in diamniotic monochorionic pregnancy. To the best of our knowledge, fewer than 100 cases have been reported in literature. Although a wide variety of presentations have been described in clinical reports, the characteristic features on MRI which distinguish FIF from teratoma have not been well delineated. Here we present a case of fetus-in-fetu in which characteristic MDCT and MR findings were used to diagnose FIF preoperatively and successfully differentiate it from teratoma. Although both CT and MRI can be used for definitive preoperative diagnosis of FIF, MRI is an ideal imaging modality due to inherent high tissue contrast and spatial resolution. Furthermore, MRI obviates the need for iodine contrast and eliminates the risk of ionizing radiation. We emphasize that MRI is an ideal valuable diagnostic tool for definite preoperative diagnosis of FIF and surgical planning.

Prenatal diagnosis of abdominal mass: Review of the foetus in foetu

“…The full dose of immunoglobulin should be injected in the edges of the wound, and if this were not possible any remaining volume should be injected intramuscularly in a site distant from vaccine administration. 6 None of the patients had side effects from the vaccine or the rabies immunoglobulin, which confirms their safety profiles.…”

“…Magnetic resonance imaging is gaining importance due to its high tissue contrast and spatial resolution, and it does not require exposure to radiation or intravenous contrast. 6 Some publications have described instances of elevated serum levels of ␣-foetoprotein and/or ␤-hCG in association with this disease. 2 The main condition to consider in the differential diagnosis is highly differentiated teratoma.…”

Fetus in Fetu in the Scrotal Sac

“…Distinct bony structures, such as the spine and the bones of the extremities, may be visualized using CT and MRI, both of which have enhanced the accuracy of preoperative diagnoses. 6 , 37 …”

Diagnóstico prenatal de masa abdominal. Revisión del fetus in fetu

“…La TAC detalla las estructuras que constituyen la masa, su anatomía vascular y la relación con los órganos adyacentes, importante para el abordaje quirúrgico. La RM está ganando protagonismo debido a su alta resolución espacial y discriminación entre tejidos, además evita la radiación y el empleo de contraste endovenoso 6 . Se ha descrito elevación sérica ocasional de ␣-fetoproteína y/o ␤-hCG en relación a esta enfermedad 2 .…”

“…La inmunoglobulina se inyectará en los bordes de la herida, y si no fuese posible, se pondrá el resto en una zona alejada de la vacuna por vía intramuscular 6 . Ningún caso ha presentado efectos secundarios con la vacuna ni con la gammaglobulina específica, lo que confirma su perfil de seguridad.…”