MEDICAL IMAGING

MORPHOLOGY
IN THE LABORATORY:

FETAL ICONOGRAPHIC
BICEFHAL, CASE STUDY

MEDICAL IMAGING MORPHOLOGY IN THE LABORATORY:

FETAL ICONOGRAPHIC BICEFHAL, CASE STUDY
J. ORBES1; FERNANDEZ A2; C. E. MARTINEZ3; O. VALLEJO4; A. JIMENEZ RICARDO5 CASTAO6; K. GIL7; M. LPEZ8.
1Professor Researcher IV category Medicine Program Technological University of Pereira UTP. 2 Research
Professor Tanatopraxia and Plastination Laboratory Autonomous University Foundation of the Americas,
Headquarters Pereira. 3 Directors in Radiology Technology Program and Medical Imaging University Foundation of the Andean Area 4Mdico Radiology- FUAA, 5M.D. Rector Autonomous University Foundation of the
Americas, Coordinator Plastination Laboratory Embalming and Autonomous University Foundation of the
Americas, Headquarters Pereira, 6,7y 8.Estudiantes VII Semester Medicine Autonomous University Foundation of the Americas, Headquarters Pereira.
ABSTRACT
Keywords: two-headed fetuses; Congenital malformations; Diagnostic imaging.
The birth of conjoined twins is a strange phenomenon in the delivery rooms around the world, are the
product of a single egg that for some reason did not divide; is presenta1 / 50,000 or 1 / 120,000 births; is
estimated that 50% stillborn and 35% die on the first day of life; and 70% are female. A two-headed fetus is a
product developed with two heads that are joined together through their temporoparietal medial portions
being connected vascularized organs and sharing with each other or not; are monozygotic type and produced by abnormal or incomplete separation of the axial portion of the bilaminar germ disc in advanced stages
of embryonic development.
In this paper a case of two-headed Siamese female, whose specimen was part of the collections of Morphology Embryology Laboratory of the Technological University of Pereira, who for record medical history and
informed consent of the mother who is exposed delivered to the University underwent pathological description to explain aspects of the possible causes of these accidents and the prenatal diagnosis of these congenital defects and postmortem imaging diagnosis.
INTRODUCTION
The birth of conjoined twins is a strange phenomenon in delivery rooms around the world, they are the result
of a single egg that for some reason did not split; is presenta1 / 50,000 or 1 / 120,000 births; it is estimated that
50% stillborn and 35% die on the first day of life; and 70% are gender femenino.1
A bicephal fetus is a product developed with two heads that are joined together through their medial
portions temporoparietal being connected vascularized and not sharing or organs together; They are
monozygotic type and produced by abnormal or incomplete separation of the axial portion of the germinal
disc bilaminar embrionary1,2 in advanced stages of development.
The twinhood together can be classified by region by coming together from two well-developed, independent and symmetrical individuals, united only by a small surface connection, even those who are represented
only by portions of mutually bonded body (asymmetric) or included in Developed 3 one more guest.
Two contradictory theories exist to explain the origin of the Siamese twins; the oldest theory is fission, in
which the fertilized egg is partially divided; the second and generally accepted theory is fusion, in which a
fertilized egg is completely separated, but stem cells are also present in the other twin, allowing melt the
twins. Conjoined twins as well as those who are not, they share one common chorion, placenta and sac
amnitico4.

In this paper a case of two-headed Siamese female, whose specimen was part of the collections of Embryology Laboratory of Morphology of the Technological University of Pereira, who for registration of medical
history and informed consent of the mother is exposed who He gave the University underwent pathological
description in order to expose aspects of the possible causes that originated them and prenatal diagnosis
of these birth defects and imaging diagnosis postmortem.
OBJECTIVES:
External Morphological study conduct and Radiological Simple, cephalocaudal of a two-headed fetus in
order to identify defects that are present and analyze the risk factors that led to its genesis.
MATERIALS AND METHODS:
The external morphological study was performed by simple radiology and anatomical all a two-headed
female fetus, child of a patient treated at the Clinic Comfamiliar City -Risaralda Pereira, Colombia S.A.
Conventional radiographs were performed in a private imaging center city; being used a Philips DSI, DSI
PHILIPS SUPER 80CP, diagnostics 76 plus, on which the specimen is placed in fetal projections A-P, P-A and side.
CLINICAL CASE
Tri patient pregnant 37 weeks pregnant with 25.5 (diagnosed by ultrasound). His two previous pregnancies had
a stillborn as a result of 15 days and a living child of nine years, states that the current pregnancy is different
from the previous father.
It is performed taking ultrasound fetal anatomical detail that reveals: twin, monochorionic, ovular Pregnancy, which has two heads attached to the neck, sharing trunk and limbs (two upper limbs and lower two are
observed), with unique heart structure and female external genitalia.
Both fetuses have acrania-anencephaly sequence, with exposed brain mass into the amniotic cavity and
bilateral lip and palate defect. It is present in the two backbones suffering cranial fusion thoracic level
portion, where the curvature starts defect to the lumbar portion. (See Figure Nro 1)
Given the findings of ultrasound and with full knowledge of these by the patient, IVG is requested by transperitoneal segmental cesarean section.
During the procedure for its extraction fetal cephalic pole is done, no way out large amount of amniotic fluid
dark brown, it gives birth assisted normal placenta and annexes, was 600grs weight, height 26cm. (See Figure
Nro. 1)

Figure Nro. 1. Photograph of Fetus Two Headed, A. View Previous, note its two
heads, the presence of cleft lip in both the ventral thorax incision anatomopatgico own study. B. Rear View, is notorious Occipital encephalocele. C.
Vista Ridge, Appreciate spina bifida. Photographs taken with a camera Sonic
SDC - HX 100v.

The imaging findings by employing conventional radiology possible to identify in their images:

Figure no. 2. A. Specimen in Vista AP supine. B right lateral decubitus AP Vista. C. having left lateral decubitus
AP.

Macroscopic Description:

Fetus only 25 weeks observed bicfalo presence of large defects of spinal fusion from the upper lumbar spine,
thoracic spine and cervical; continuity solutions or defects described midline produce large myelomeningocele. The soft tissues in the neck are fused. The column is unique, broken scoliosis evidence marked mainly at
the dorsal spine that causes deformity of the ribcage.
It is of considerable importance and the presence of bilateral occipital encephalocele complete with marked
deformity of the cranial vault, two in number, with deformed lateral flattening and widening. Cranial vaults
are full encephalocele secondary empty described both skulls, coexisting a frontal flattening frontomaxillary
default angle increased with the midline of the face cleft lip and palate on both sides symmetrically accompanied by exophthalmos; the other structures of the two sides no significant alterations.
Thoracoabdominal region is normal and short morphology; no viscera are evaluated on the images evaluated. The bone structures are of normal morphology, no alterations in the diaphysis, metaphysis or epiphysis
of the long bones; increase in the length of the long bones of both upper flues, radial and ulnar members is
evident although their morphology is normal, there is no a continuity solution or cortical defects.
At the level of the upper limb, it was shown that the carpal bones and phalanges are symmetrical and normal
morphology, with respect to the lower limbs are symmetrical feet without alterations only abundant villi
(hirsutism).
DISCUSSION
The start of a twin pregnancy from a single egg that is fertilized by a sperm produces a zygote, which for unknown reasons is divided into two and each portion develops a fetus, so tantocada one has its own umbilical
cord, but despite this shared placenta and gestational sac, denominating twins. It can also be two eggs that
are fertilized by two separate sperm, allowing each fetus has its own gestational sac, cord and placenta, giving
birth to babies with different genetic characteristics, known as twins. 5, 6, 7 8.
During the development of fetuses different genetic defects can occur, the most common morphological
variations are: Blemmyas: heads without trunk - Headless: trunks without heads - anencephalic: fetuses born
without brains - Bicefalos: fetuses with two heads - Siameses: Fetuses born with some part of his body Kingdom9.
In the twins they begin their differentiation from the first 10 days after fertilization. But when conjoined occurs
at about day 13, this delay is causing structural abnormalities in cells, so that fetuses share different organs,
these fetuses are classified EN7, 8, 9,10
Thoracopagus, Xifpagos O Esternphagus: fetuses that are connected by the region of the chest or abdomen and comprise 75% of cases.

 Pigpagos: fetuses that are fused in the back, usually at the level of the pelvis, sacrum or tailbone, in addition
to the completion of the digestive tract in a single common pathway, although there may be malformations
of the genitourinary tract. These represent 19% of cases.
Craniopagus: occurs in 1% of cases and fetuses have the characteristic of being joined at the head, often
with separate brains or share one.
Isoquipagos: Those that are attached to the pelvis lower level but just above the navel, with separate
bodies and represent 6% of cases.
Ultrasound as a tool used for diagnosis is an important early prenatal detection of congenital malformations
fetales11 input, 12permitiendo provide better diagnosis for optimal maternal and child care and gives the
expectant mother greater safety on the state of health of your offspring; in the case described, early ultrasound performed in the clinic and prenatal diagnosis, was categorical in diagnosing the presence of two-headed twins, allowing proper handling and resolution of the case successfully allowing you to take legal doctor
right decisions in the precise moment.
Bibliogrfica10 in review, 11, 12, 13, 14, 15,16 a match was found that two-headed twins are even more rare,
its incidence varies between 1:50 000 and 1: 200 000 live births. Although the reason is unknown, between
90% and 95% of female Siamese exhibit.
It is considered that there are epigenetic factors that can modify the birth of the fetus and cause birth defects;
deficiencies in the consumption of preconception folic acid from the mother are related to defects in neural
tube closure, this being a possible cause of spinal disorders of the fetus factor, causing anencephaly and spina
bifida in it, another risk factor to highlight is the age of the patient as it has been scientifically proven that
mothers over 35 years have a risk of having a malformed child poly 2.4 times greater than under 35 aos
13,14,15, although reportedly development bicephalous cases of fetuses in mothers under 20 years 16.
And in nonclinical but study of pathological specimens areas, it is important to note that these specimens
obtained from in-hospital cases are a bright side and cause fascination among observers, however within the
laboratory are a vital teaching tool Clinical embryology and Dysmorphology once carried imageneological
studies are real tools that estimate previous diagnoses for other cases which despite its low prevalence are
presented in the population, contributing to a better explanation of these phenomena of developmental
biology ranging beyond display in a jar with water and formalin in a dusty glass case; therefore it is important
to develop a line of research that integrates dysmorphology, medical Imaging, and preservation technical
S1o with BioDuro (Plastination) of laboratory specimens in order to identify possible partners and primary
malformations, and other than perhaps escape the histopathology study and may serve to sensitize the
population in prenatal care that must have once individuals begin their sexual life.
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THANKS
The research group wants to thank the Higher Education Institutions Autonomous University Foundation of
the Americas, Headquarters Pereira, Universitaria Andean Foundation, Sectional Pereira, Central University
of Valle del Cauca, Technological University of Pereira and especially companies Diagnostic center for High
Technology Eje Cafetero SA (Cedicaf ) and Asociados SAS Radiologists For his undeniable commitment to the
scientific research transdiscipliry in areas of health and its impact on the academic and social community.