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BACKGROUND: The condition of monozygotic, monochorionic triplet fetuses with a pair of conjoined twins is extremely rare (close to one in a million births), presents challenges in its management, and with poor prognosis. CASE REPORT: We report a case of monochorionic diamniotic triplet pregnancy, ultrasound at 14 weeks shows a pair of conjoined thoracopagus fetuses, sharing heart, liver, and umbilical cord, in addition to omphalocele. The third fetus, without malformations, presents signs of early heart failure compatible with twin-to-twin transfusion syndrome. It was decided to carry out expectant management where at 18 weeks, intrauterine death of the three fetuses occurs. An abortion is performed by hysterotomy. CONCLUSIONS: The treatment in these cases is discussed, three management options have been proposed: expectant management, selective reduction of the conjoined fetuses, or termination of the pregnancy. A review of the literature found only 12 cases with this combination of pathologies, in which only 3 normal fetuses (25%) survived and none of the conjoined twins survived. To our knowledge, this case is the first of a monochorionic triplet pregnancy with conjoined fetuses complicated with early twin-to-twin transfusion.

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Conjoined twins (CTs), popularly referred to as Siamese twins, are a rare anomaly due to monochorionic and monoamniotic twin pregnancies. Dicephalus dibrachius dipus, a type of parapagus conjoined twin which is characterized by possessing two arms, two legs, a single trunk and two heads, epidemiologically, is an even rarer occurrence of CTs. In this article, a rare, well-preserved anatomical specimen of a dicephalus dibrachius dipus conjoined twin is presented. This study was conducted in a specimen which is part of the collection of the Embryology Museum of the institution by donation and approved by the Research Ethics Committee (REC). The female conjoined twins were born at full-term by cesarean section in the 1970s and died hours after birth. A thorough anatomical description was made through observational analysis, computed tomography and 3D reconstructed images. Major abnormalities were observed in the cardiovascular, respiratory and digestive systems. The internal anatomy exhibited a heart with three atria, two ventricles, two aortic arches, two pulmonary arteries, one innominate venous trunk and a respiratory system with two tracheas and four lungs. No other report was similar to our three atria heart description. This article provides a thorough anatomical description of all systems, which is valuable information for further studies on CTs.

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BACKGROUND: Parapagus diprosopus are conjoined twins characterized by craniofacial duplication and only one body, representing one of the rarest types of these twins. Their occurrence has been recorded in different species of vertebrates, including humans, but few cases have been studied in domestic pigs. CASE: A pair of conjoined twin pigs was studied using x-rays, computed tomography, and necropsy. The abnormalities found were compared with those of the rare swine cases presented in the literature as well as with other species, and the different etiopathogenetic possibilities were addressed. The degree of duplication of the head bones decreased caudally, as did that of the structures of the central nervous system. In the two oral cavities, there was a complete cleft palate. All the cervical vertebrae and thoracic vertebrae up to T3 were partially duplicated. The heart and great vessels were normal, as were the other thoracic and abdominal organs. CONCLUSIONS: The conjoined twin pigs of this study are a case of parapagus diprosopus tetraophthalmus triotus, presenting the same pattern of abnormalities of human diprosopus and that of other species. The scarcity of detailed studies on craniofacial duplication in pigs and the lack of a definitive explanation on the etiology and pathogenesis of conjoined twins shows the need for further research and the publication of more cases.

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INTRODUCTION: The optimal approach and therapy method for the acardiac twin with a reverse arterial perfusion sequence has not yet been established. The aim of this study was to determine the clinical practice patterns among international fetal therapy units in their management of these cases. METHODS: A survey was sent to fetal centers across the world via email between December 2020 and December 2021. RESULTS: Responses were obtained from 77% contacted centers. The most frequent ultrasound variables used in the evaluation of twin reverse arterial perfusion sequence include echocardiographic assessment of the pump twin and umbilical artery Doppler waveforms in the acardiac and pump twins, in 90% and 80% of the centers, respectively. Most centers in Europe and Latin America propose an in utero intervention in all cases. Most centers in Europe and Latin America prefer interstitial laser ablation, whereas radiofrequency ablation (RFA) is preferred in North America. The earliest gestational age for an intervention is on mean 13 weeks in Europe, which is earlier than the other geographic areas (p = 0.001). CONCLUSIONS: Most centers agreed that antenatal evaluation should include echocardiography along with the UA Doppler waveform measurements, and the most frequently used interventions were interstitial laser ablation or RFA at a median between 14 and 26 weeks.

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The surgical procedure to separate conjoined twins represents a rare and major challenge. One of the most feared perioperative scenarios is the presence of coagulopathy secondary to bleeding. We present a case of the surgical separation of ischiopagus tetrapus twins using a patient blood management strategy encompassing a tranexamic acid infusion, intraoperative viscoelastic testing, and early fibrinogen supplementation to reduce bleeding and transfusions. This approach allowed early detection and treatment of acquired hypofibrinogenemia, which resulted in minimal exposure to blood products. This case reflects the increasing clinical interest in early avoidance of fibrinogen deficiency in complex noncardiac pediatric surgery.

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Este estudo reporta um caso de gêmeos xifópagos (thoracopagus) identificados em um frigorífico no Sudeste paraense. Durante as linhas de inspeção do abate, identificou-se um dos animais com gestação gemelar avançada, sendo que os fetos encontravam-se unidos pela cavidade torácica. Aos fetos com esse tipo de duplicidade dá-se o nome de gêmeos siameses ou xifópagos. Tal condição é uma alteração congênita rara de etiologia muitas vezes considerada indefinida, podendo ser resultado de defeitos genéticos, de agentes infecciosos ou de fatores ambientais. Os fetos apresentaram morfologia homogênea e simétrica, compondo dois indivíduos equivalentes, ambos machos. O relato de anomalias, como a identificada nos fetos, permite monitorar a ocorrência de casos semelhantes, além de identificar e relatar possíveis defeitos hereditários nos bovinos.

This study reports a case of xiphopagus twins (thoracopagus) identified in a slaughterhouse in southeast Pará. During the slaughter inspection line, one of the animals was identified with advanced twin pregnancy and the fetuses were united by the thoracic cavity. Fetuses with this type of duplicity are called Siamese or Xiphopagus. This condition is a rare congenital alteration often considered of undefined etiology, and may be the result of and genetic defects, infectious agents, or environmental factors. The fetuses presented homogeneous and symmetrical morphology and were two equivalent individuals, both males. The report of anomalies, such as the one identified in the fetuses, allows monitoring the occurrence of similar cases, in addition to identifying and reporting possible hereditary defects in cattle.

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Background: Congenital anomalies are structural, functional, or metabolic defects caused by a combination of environmental, genetic, or even iatrogenic factors. Genetic defects, which can be inherited, are more common in purebred dogs. Teratogenic factors such as radiation, toxins, chemical agents, infectious diseases, mechanical influences, drugs given to the mother, and nutrition can affect the litter during gestational development. The incomplete division of a fertilized egg results in monozygotic, conjoined or Siamese twins, which are animals with complete or incomplete duplications. This paper reports on an adult bitch with monocephalus dipygus dibrachius and the surgical procedures. Case: A 2-year-old female Shih Tzu weighing 5 kg was admitted to a veterinary clinic, presenting with swelling and myiasis near the anus and several development disorders, characterized by 2 pelvises, 2 anuses, 2 vulvas, 2 forelimbs and 6 hindlimbs. Her physiological parameters were otherwise normal. Only the dog's myiasis was treated at this time due to the owner's financial straits. After 5 months, the owner brought the bitch back to the veterinary clinic because the animal presented with fecaloma in 1 of the anuses. Radiography revealed numerous alterations: seven lumbar vertebrae with marked vertebral axis deviation, reduced disc space, as well as ankylosis and fused ventral spondylosis at L6 and L7. Two pelvises fused medially by the wings of the ileum, with slight deviation and thinning of pelvic bones. Four hip joints and medial joints with pelvic avulsion and bone remnants of the pelvic limbs. Acetabular tearing slightly flattened femoral head and thickened femoral neck. Caudal vertebrae and vertebral axis located in left pelvis. Left lateral patella inserted in the trochlear groove and lateral dislocation of right patella. Right patellofemoral joint with smooth surface, preserved intra-articular density and cranial displacement of the tibia relative to the femoral condyles (cranial cruciate ligament rupture). An ultrasound analysis revealed 2 bladders. Two months later surgery was performed due to recurrent complications. During laparotomy 2 uteruses, 2 bladders and bifurcation of the intestine were observed. Ovariosalpingohysterectomy was performed in both uterus and enterectomy of the problematic intestinal portion. After 2 days of the surgery, blood transfusion was performed. After 2 days of the transfusion, there was extravasation of yellow fluid from the surgical cut and abdominal palpation was indicative of bladder rupture, so the patient was sent to emergency surgery. Unilateral nephrectomy and ureterectomy, and ruptured bladder cystectomy were performed. The dog remained hospitalized for 24 days after surgery, before it was released. Discussion: The classification of conjoined twins is based on the location of the junction and the number of limbs. Monocephalus dipygus dibrachius was diagnosed based on the fact that the dog had 1 skull, 2 thoracic limbs and 4 pelvic limbs, as well as the corresponding genitourinary and gastrointestinal tract alterations. Imaging scans are extremely important for a proper diagnosis to ensure appropriate surgery planning. The bitch was the result of inbreeding between a male dog and its offspring, which probably contributed to this malformation. There are very few reports of surviving adult conjoined animals, and even fewer descriptions of successful surgical treatments. To the best of knowledge of the authors, there are no previous reports of a surviving adult dog suffering from this malformation.

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Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus is incorporated within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. In most cases, the diagnosis is made in infants or young adults. To date, the oldest patient reported in the literature was 47 years old. We describe the case of a 65-year-old patient with FIF, now the oldest reported in the literature. Our patient meets all the diagnostic criteria for FIF, including the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF should be considered in the differential diagnosis of abdominal masses, typically recognized in infancy. Symptoms arise from mass effects. Surgical resection should be performed due to the potential for malignant transformation.

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Conjoined twins (CTs) are a rare complication from monochorionic and monoamniotic twin pregnancies. We describe the use of 3D technologies, including 3D virtual and 3D physical models on prenatal evaluation of one parapagus CT. A 16-year-old G1P0 woman was referred for fetal magnetic resonance imaging (MRI) anatomical evaluation of a CT at 28 weeks of gestation. 3D images of the fetal surface were generated by the software during the examination for spatial comprehension of the relationship between the fetal parts. The pair of CTs died at the 32nd week of gestation, a few hours after cesarean section. 3D technologies are an important tool for parental counseling and preparation of the multidisciplinary care team for delivery and neonatal assistance and possible surgical planning for postnatal separation in CTs cases.

Gêmeos unidos (GUs) são uma complicação rara de gestações gemelares monocoriônicas e monoamnióticas. Descrevemos o uso de tecnologias 3D, incluindo modelos 3D virtuais e físicos, na avaliação pré-natal de GU parapagus. Mulher de 16 anos, G1P0, foi encaminhada para avaliação anatômica por ressonância magnética (RM) fetal de GU com 28 semanas de gestação. Imagens 3D da superfície fetal foram geradas pelo software durante o exame para compreensão espacial da relação entre as partes fetais. O par de GUs morreu na 32ª semana de gestação, poucas horas após a cesariana. As tecnologias 3D são uma importante ferramenta de aconselhamento dos pais e de preparação da equipe multiprofissional para o parto e a assistência neonatal, além de possível planejamento cirúrgico para separação pós-natal em casos de GUs.

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Abstract Conjoined twins (CTs) are a rare complication from monochorionic and monoamniotic twin pregnancies. We describe the use of 3D technologies, including 3D virtual and 3D physical models on prenatal evaluation of one parapagus CT. A 16-year-old G1P0 woman was referred for fetal magnetic resonance imaging (MRI) anatomical evaluation of a CT at 28 weeks of gestation. 3D images of the fetal surface were generated by the software during the examination for spatial comprehension of the relationship between the fetal parts. The pair of CTs died at the 32nd week of gestation, a few hours after cesarean section. 3D technologies are an important tool for parental counseling and preparation of the multidisciplinary care team for delivery and neonatal assistance and possible surgical planning for postnatal separation in CTs cases.

Resumo Gêmeos unidos (GUs) são uma complicação rara de gestações gemelares monocoriônicas e monoamnióticas. Descrevemos o uso de tecnologias 3D, incluindo modelos 3D virtuais e físicos, na avaliação pré-natal de GU parapagus. Mulher de 16 anos, G1P0, foi encaminhada para avaliação anatômica por ressonância magnética (RM) fetal de GU com 28 semanas de gestação. Imagens 3D da superfície fetal foram geradas pelo software durante o exame para compreensão espacial da relação entre as partes fetais. O par de GUs morreu na 32ª semana de gestação, poucas horas após a cesariana. As tecnologias 3D são uma importante ferramenta de aconselhamento dos pais e de preparação da equipe multiprofissional para o parto e a assistência neonatal, além de possível planejamento cirúrgico para separação pós-natal em casos de GUs.

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The present report describes a case of conjoined twins of the cephalo-thoraco-omphalopagus deradelphous type in cats. A feline female was transferred to our veterinary hospital as an emergency for dystocic labor. The stillborn was subjected to radiographic evaluation, and a single skull and two complete distinct vertebral columns were found. Anatomopathological examination revealed that the twins presented the head, chest, and umbilicus as the main points of union and were classified as the cephalo-thoraco-omphalopagus type. In addition, the twins had unique and well-developed faces, which allowed them to be classified as deradelphous. This malformation is rare in domestic animals, and to the best of our knowledge, this type has not been reported in felines. Further studies are warranted on this embryonic alteration, primarily because its etiology remains unknown.(AU)

O presente relato descreve um caso de gêmeos siameses do tipo cefalotoraconfalopago deradelfo em gatos. Uma fêmea felina foi atendida na emergência do hospital veterinário em trabalho de parto distócico. Os natimortos foram encaminhados para avaliação radiográfica e constatou-se que apresentavam um único crânio e duas colunas vertebrais completas e distintas. O exame anatomopatológico evidenciou que os gêmeos possuíam cabeça, tórax e umbigo como principais pontos de união, sendo classificados como cefalotoraconfalopago. Além disso, os gêmeos apresentaram face única e bem desenvolvida, o que permitiu classificá-los como deradelfos. Esse tipo de malformação é raro em animais domésticos, e não foi encontrado nenhum trabalho em felino com a mesma classificação do presente relato. Há necessidade de mais estudos sobre essa alteração embrionária, pois a etiologia do processo ainda não foi esclarecida.(AU)

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RESUMO Os gêmeos unidos são formados nos estágios iniciais da gestação. A varidade parapagos dicefálicos costumam apresentar corações fundidos com arco aórtico, transposição de grandes vasos e ausência de baço e situs inversus. Assim, é importante o diagnóstico precoce dessa condição, pois ela se relaciona diretamente com o prognóstico. Nesse relato, tem-se uma paciente primigesta, em que através de Ultrassonografia foi diagnosticada gestação bigemelar imperfeita, havendo divisão incompleta dos embriões ao nível do tórax, sendo percebidas duas cabeças e duas colunas cervicais e torácicas, ligadas a um corpo único, composto por uma pelve, duas pernas e dois braços (parapagos dicefálicos), com movimentação e atividade cardíaca presentes. Diante disso, foi realizada conduta expectante, até que com o aumento do sangramento e cólica a paciente foi até o hospital, onde foi feita macroindução e posterior curetagem pós-abortamento. Assim, com o desenvolvimento da ultrassonografia foi que esse diagnóstico passou a ser possível, facilitando a escolha da via de parto e planejamento cirúrgico. PALAVRAS-CHAVE: Gêmeos, gêmeos unidos, diagnóstico pré-natal

ABSTRACT United twins are formed in the early stages of pregnancy. The dicephalic parapagus variety usually presents fused hearts with aortic arch, transposition of large vessels and absence of spleen and situs inversus. Thus, an early diagnosis of this condition is important, as it is directly related to the prognosis. In this report there is a primigravid patient, in whom an imperfect twin pregnancy was diagnosed through ultrasonography, with incomplete division of the embryos at the level of the thorax, with two heads and two cervical and thoracic columns, connected to a single body, consisting of a pelvis, two legs and two arms (dicephalic parapagus), with movement and cardiac activity present. Therefore, an expectant management was performed, up until the patient went to the hospital with increased bleeding and colic, when labor induction and subsequent post-abortion curettage were performed. Thus, with the development of ultrasonography, this diagnosis became possible, facilitating the choice of the mode of delivery and surgical planning. KEYWORDS: Twins, united twins, prenatal diagnosis

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BACKGROUND: Craniopagus twins represent a rare and complex congenital malformation characterized by conjoined twins fused at the cranium. Craniopagus is challenging for patients' families and surgeons, and accurate confirmation of the extent of cranial fusion is a complex process. Most information regarding the surgical anatomy of this rare condition is obtained through analysis of ultrasonographic, magnetic resonance, or computed tomographic images. A multidisciplinary team plays a key role in obtaining such information and in parental counseling and coordination of various complex processes for optimal postnatal care of these twins. The extent of fusion is usually determined based on conventional clinical methods, such as imaging studies. METHODS: Imaging software is being used in recent times to create three-dimensional reconstruction images and for virtual navigation to investigate the skulls and brains of craniopagus twins. However, the acquisition and maintenance costs of such sophisticated medical software may be unaffordable for medical centers in developing countries. To overcome this limitation, we investigated the role of open or free source software for accurate determination of complex malformations of the skull and brain of craniopagus twins.

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Congenital malformations are morphofunctional abnormalities of tissues and organs that can occur during embryonic or fetal development in all animal species. Among these, dicephalus is characterized by the development of an individual with two heads and two necks, due to the total duplication of facial, cranial, and brain structures. Reports of dicephalus in cattle are scarce and do not normally emphasize radiographic and bone anatomy characteristics. The objective was to describe a case of a stillborn dicephalus calf. The duplication of the head, brain, neck, and two thoracic vertebral columns, isolated from each other, with 13 vertebrae each was verified radiographically. There were 13 pairs of ribs, the ones on the right side articulated with the thoracic spine on the right and the left ones with the spine on the left. Caudally at T13, there was only one lumbar spine, sacral and coccygeal. In the ventrodorsal projection, L1, L2, L3, and L6 had the shape of a butterfly (suggestive of hemivertebrae). At necropsy, in addition to craniocervical and spinal morphological changes, collapsed lungs, duplication of the heart with anastomosis between the aortic arches of the hearts, and duplication of the upper digestive tract were observed. Additionally, there was arthrogryposis of the pelvic limbs. Corpse maceration, followed by the skeletal assembly, showed the bone changes previously observed and confirmed the suspicion of hemivertebrae.

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Congenital malformations are morphofunctional abnormalities of tissues and organs that can occur during embryonic or fetal development in all animal species. Among these, dicephalus is characterized by the development of an individual with two heads and two necks, due to the total duplication of facial, cranial, and brain structures. Reports of dicephalus in cattle are scarce and do not normally emphasize radiographic and bone anatomy characteristics. The objective was to describe a case of a stillborn dicephalus calf. The duplication of the head, brain, neck, and two thoracic vertebral columns, isolated from each other, with 13 vertebrae each was verified radiographically. There were 13 pairs of ribs, the ones on the right side articulated with the thoracic spine on the right and the left ones with the spine on the left. Caudally at T13, there was only one lumbar spine, sacral and coccygeal. In the ventrodorsal projection, L1, L2, L3, and L6 had the shape of a butterfly (suggestive of hemivertebrae). At necropsy, in addition to craniocervical and spinal morphological changes, collapsed lungs, duplication of the heart with anastomosis between the aortic arches of the hearts, and duplication of the upper digestive tract were observed. Additionally, there was arthrogryposis of the pelvic limbs. Corpse maceration, followed by the skeletal assembly, showed the bone changes previously observed and confirmed the suspicion of hemivertebrae.(AU)

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OBJECTIVE: To review the perinatal and long-term outcomes of symmetric and ventrally conjoined twins evaluated prenatally by ultrasound and fetal magnetic resonance imaging (MRI). METHODS: From March 2010 to January 2019, cases of symmetric and ventrally conjoined twins, who were prenatally diagnosed and referred to the Clínica Diagnóstico por Imagem (CDPI), Rio de Janeiro, Brazil, for prenatal evaluation by ultrasound and MRI were selected. The postnatal information was collected from hospitals where the twins were born and/or treated and from parents' verbal and written information. RESULTS: Four cases of symmetrical and ventrally conjoined twins were selected. Of these, two were omphalopagi and two thoracopagi. One pair of thoracomphalopagus died early in utero and the other died 6 days after birth. The outcome of the two omphalopagus pairs were separation in emergency surgeries after birth, with neonatal demise of one of the twins due to congenital malformations. In cases of omphalopagi, fetal MRI presented important information of the twins' anatomy before emergency separation of both pairs. CONCLUSION: Despite the apparently similar conditions of twins with ventral fusion, ventrally attached twins have very different outcomes, most adverse for thoracomphalopagus and related to the singular anatomy of the pair, associated malformations and the extension of the adhesion, requiring individual evaluation of the cases. Fetal MRI is as an important tool for the postnatal surgery management of twin neonates, providing crucial information in cases where urgent separation is required.

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Antecedentes: Fetus in fetu (FIF) es una rara anomalía congénita de gemelos monocigotos asimétricos, donde el gemelo parásito se desarrolla anormalmente dentro del cuerpo del gemelo huésped. Actualmente hay menos de 200 casos reportados a nivel mundial siendo este el segundo caso en Honduras. Caso clínico: Se reporta el caso de un paciente masculino, recién nacido a término en la sala de maternidad del Hospital San Felipe, quien a su nacimiento se observó distensión abdominal, hernia umbilical, hernia inguino-escrotal izquierda y tumoración en el hipocondrio izquierdo por lo que se decide realizar una radiografía anteroposterior toracoabdominal revelado un tumor en la región izquierda del abdomen con presencia de calcificaciones. Se refiriere al Hospital Escuela Universitario donde se le efectuó un ultrasonido abdominal total con reporte de masa heterogénea de 5 cm3 de volumen con componente cálcico en su interior, que tuvo que ser correlacionada con tomografía axial computarizada con reconstrucción 3D dando como resultado masa heterogenia con huesos axiales y apendiculares en su interior compatible con FIF. Se realizó intervención quirúrgica con resección de tumoración retroperitoneal y sus anexos sin secuelas ni complicaciones por lo cual se da alta médica. Conclusión: Aunque el FIF es una enfermedad muy rara, el tratamiento de elección será la resección de la masa y su pronóstico es favorable cuando la masa se ubica en el área retroperitoneal. Se puede observar que la tomografía tridimensional es una técnica de imagen útil para la diferenciación entre un FIF y un teratoma en el diagnóstico preoperatorio...(AU)

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BACKGROUND: Asymmetric or heteropagus conjoined twins is a rare occurrence, with an incidence of one case in 1-2 million. Conjoined twins are classified according to their symmetry, place of fusion, and grade of duplication. METHODS: We report here an extremely rare presentation of parasitic twins not described before. We describe macro and micro anatomic alterations and discuss the aspects of this peculiar presentation and the importance of prenatal diagnosis. RESULTS: The case of a twenty-three-year-old patient, with monochorionic, monoamniotic asymmetrically-conjoined twin pregnancy, discovered at 29 weeks of gestational age. We believe that this report calls attention to this presentation and the importance of prenatal care and management. The twins were delivered vaginally without life. The twins' combined weight was 1.300 gr. They were bonded in the left cervical region. CONCLUSION: This report may help to find strategies for clinical decisions in future cases. Antepartum diagnosis is important to the management, preoperative planning, and outcomes. Prenatal imaging exams like echocardiography, CT, MRI, and ultrasonography are feasible and can provide relevant information about malformation severity and prognosis.

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SUMMARY BACKGROUND: Asymmetric or heteropagus conjoined twins is a rare occurrence, with an incidence of one case in 1-2 million. Conjoined twins are classified according to their symmetry, place of fusion, and grade of duplication. METHODS: We report here an extremely rare presentation of parasitic twins not described before. We describe macro and micro anatomic alterations and discuss the aspects of this peculiar presentation and the importance of prenatal diagnosis. RESULTS: The case of a twenty-three-year-old patient, with monochorionic, monoamniotic asymmetrically-conjoined twin pregnancy, discovered at 29 weeks of gestational age. We believe that this report calls attention to this presentation and the importance of prenatal care and management. The twins were delivered vaginally without life. The twins' combined weight was 1.300 gr. They were bonded in the left cervical region. CONCLUSION: This report may help to find strategies for clinical decisions in future cases. Antepartum diagnosis is important to the management, preoperative planning, and outcomes. Prenatal imaging exams like echocardiography, CT, MRI, and ultrasonography are feasible and can provide relevant information about malformation severity and prognosis.

RESUMO BACKGROUND: Gêmeos parasitas assimétricos ou heterópagos são uma ocorrência rara, com incidência de um caso em 1-2 milhões. Os gêmeos siameses são classificados de acordo com sua simetria, local de fusão e grau de duplicação. MÉTODOS: Relatamos aqui uma apresentação extremamente rara de gêmeos parasitários não descritos anteriormente. São descritas alterações macro e microscópicas e discutidos aspectos relevantes dessa malformação e da importância do diagnóstico pré-natal. RESULTADOS: Um caso de uma paciente de 23 anos de idade, com gestação monocoriônica, monoamniótica de gêmeos siameses assimétricos diagnosticada com 29 semanas de idade gestacional. Acreditamos que este relato chama a atenção para esta apresentação e para a importância do cuidado e manejo pré-natal. Os fetos nasceram de parto vaginal já sem vida, pesando em conjunto 1.300 gramas, e eram unidos pela região cervical esquerda. CONCLUSÃO: Este relato pode ajudar a encontrar estratégias para a decisão clínica em casos futuros. O diagnóstico pré-natal é fundamental para o manejo e planejamento pré-operatório. Exames de imagem como ecocardiografia, tomografia computadorizada, ressonância magnética e ultrassonografia são factíveis e podem fornecer informações-chave sobre a gravidade e prognóstico da malformação.

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