SDMRad

 Radiological Findings, Disease course, and Management

 

 CT

 NCCT                    

 

 

 

 

 

 

 

 

   

 

 

 CECT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Findings

• Fairly well defined non enhancing hypodense/ cystic lesion (HU 15 to 30) with few calcific and fat densities in the pre sacral region causing mass effect on the urinary bladder, rectum and sigmoid colon with resultant significant narrowing of the rectum and mild dilatation of the rest of the colon

• Superior extension of mass to L4-L5 level abutting and superiorly displacing the sigmoid colon

• Approximate measurement 3.2x2.9x2.5cm

  Impression

• A fairly well-defined non-enhancing cystic lesion with few calcific densities(elongated/oblong shaped) and few fat densities within in the pre-sacral region --- Likely Teratoma.

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 Disease course, and Management

 Operative findings:

• rudimentary fetus with umbilical cord and placenta in the pelvis  posterior to bladder and anterior to rectum measuring around 5 x 4 x 4 cm 

 Diagnosis: Fetus in fetu 

 

 

 

 

 

 

 

 

 

 

 

 

 Course in hospital:

 Patient was in NICU for 14 days and now baby is doing well

 

 Discussion

   Background

• Fetus-in-fetu (FIF) is an extremely rare abnormality

• occurs secondary to abnormal embryogenesis in a monochorionic diamniotic pregnancy where a non-viable fetus becomes enclosed within a normally developing fetus

• Most patients present with an abdominal mass in the 1st year of life.

• embryogenesis of fetus-in-fetu- two schools of thought:

    -some propose it occurs from the anomalous embryogenesis in a              diamniotic monochorionic twin pregnancy in which a malformed                monozygotic twin lies within the body of its fellow twin

    -others consider it to represent a highly organised teratoma

• Location: Most occur in the abdomen / retroperitoneal cavity

    other sites-cranial cavity, mediastinum, scrotum

 

 Imaging findings

 Plain radiograph and CT

• May typically show a calcified abdominal mass with some components favouring fetal parts within the abdomen (or rarely other parts) of another neonate

 Differential diagnosis

 Intrabdominal teratoma: Differentiated by

• its embryological origin,

• its unusual location in the retroperitoneal space,

• its invariable benignity,

• the presence of vertebral organization with limb buds and well-developed organ systems

 

 Treatment and prognosis 

• The treatment of choice is total excision. It is considered relatively benign. 

 

References

• R. (n.d.). Fetus in fetu | Radiology Reference Article. Retrieved from https://radiopaedia.org/articles/fetus-in-fetu