A parapagus dicephalus tripus tribrachius conjoined twin with a unique morphological pattern: a case report

Background

Conjoined twinning is a rare congenital malformation with an incidence of about 1.5 per 100,000 births. Because no consensus has been reached regarding the dysmorphology, thorough descriptions of conjoined twins as part of teratological collections can be useful to increase knowledge of this congenital malformation. In this case report, we describe a parapagus dicephalus twin from the collection of the Department of Anatomy of the University Medical Center Utrecht in the Netherlands. External anatomical characteristics were assessed through a detailed macroscopic examination and internal characteristics by means of whole-body computed tomography and magnetic resonance imaging (3 Tesla).

Case presentation

Macroscopic examination showed a Caucasian male parapagus dicephalus tripus tribrachius conjoined twin a type of conjoined twinning in which there are two heads side by side, one rump, and three upper and three lower limbs. In addition, anencephaly was observed in the left twin. Radiological imaging showed a normal central nervous system in the right twin and absence of the calvaria, cerebrum, diencephalon, and mesencephalon in the left twin. There was clear duplication of the vertebral column, rib cage, respiratory system, and gastrointestinal system at least up to and including the first part of the duodenum. The heart consisted of a monoatrium with two separate ventricles. There was a fused liver with a single gallbladder, a single spleen, three kidneys, two bladders, and duplication of the penis. The third upper and lower extremities were articulating with a fused glenoid and acetabulum, respectively. The third foot showed both polydactyly and syndactyly of the toes.

Conclusion

This case report describes a unique case of a male dicephalus parapagus tripus tribrachus conjoined twin discordant for anencephaly. Radiological imaging proved to be an adequate noninvasive method to provide insights into the internal (dys)morphology of this specific specimen, improving its scientific and educational value. This approach could be generally applied to other teratological specimens, thereby strengthening arguments regarding pathogenetic hypotheses, which may lead to new or improved insights into both normal and abnormal embryonic development.

A case of conjoined twins (thoraco-omphalopygopagus tribrachius tetrapus) in lamb

Nearly completed conjoined or fused symmetrical twins are generally called diplopagus. Sheep conjoined twins have been reported less than cow. An apparently female conjoined twin lambs was examined based on external and internal features. In radiology, two vertebral columns and two pairs of the ribs were seen. Only two heads and two necks were separated (thoraco-omphalopygopagus). There were three forelimbs (tribrachius), one of which grew on dorsal region as a notomelus. Teat buds of the monsters differed in number. Only one lamb had umbilicus, including one umbilical vein, and two umbilical arteries locating besides one urinary bladder. This lamb had also one uterus. Two-separated alimentary tracts were observed in a common abdomen. Common thorax and abdominal cavities were separated by a diaphragm. There were two esophageal hiatuses, and two caval foramina but only one aortic hiatus. Two pairs of lungs and two unequal and connected hearts in a common pericardium were observed. Abnormality of the circulatory system might have caused the death of the twins.