Role of MRI in Detecting Cerebral Anomalies and Cerebral Hypoperfusion in Surviving Twin after the Co Twin Demise of Monochorionic Twin Pregnancy.

Aim: To demonstrate the role of MRI in detecting cerebral anomalies and cerebral hypo perfusion in surviving twin after the co twin demise of monochorionic twin pregnancy. Case Presentation: 28 year old second gravida came for routine antenatal sonography at 29 weeks. Her routine anomaly scan at 20 weeks for her twin gestation was unremarkable. Present antenatal sonography revealed monochorionic diamniotic twin pregnancy with demise of one of the twins at 23 weeks. Ultrasound and doppler evaluation did not exhibit abnormality in surviving twin whereas MR evaluation revealed changes in feral brain due to ischaemia. Discussion: Mono chorionic twin pregnancies are associated with numerous complications due to vascular anastomotic channels in the shared placenta. Complications include Twin to Twin Transfusion Syndrome, Anaemia - polycythemia sequence, selective intra uterine growth retardation, cotwin demise, neurological damage in surviving twin. Though prenatal Doppler sonography is often used for neurological assessment of the surviving twin, in utero Magnetic Resonance Imaging of foetal brain aids in definitive diagnosis of cerebral pathologies. Conclusion: MRI plays an important role in assessing cerebral hypo perfusion injuries and cerebral anomalies.

Pseudo Meig's Syndrome: An Unusual Presentation.

Aim: To describe the radiological findings in a case of pseudo Meig’s syndrome with rare association of pericardial effusion. Presentation of Case: We report a case of pseudo Meig's syndrome who also had pericardial effusion. The patient had sonography and MR imaging of the abdomen which showed uterine fibroid associated with bilateral pleural effusion, ascites and pericardial effusion. Subsequently, the patient underwent hysterectomy with bilateral salpingectomy following which ascites, pleural effusion and pericardial effusion resolved. Histopathological examination confirmed uterine leiomyoma with degenerative changes. Discussion: Pseudo-Meig's syndrome is a condition which describes the association of any ovarian tumor (benign or malignant) other than ovarian fibroma or any pelvic tumor with pleural effusion and ascites. Association of pericardial effusion along with this condition has been rarely reported. Most common tumors associated with this entity described in previous literature include leiomyoma of uterus and broad ligament, germ cell tumors etc. It becomes highly important to identify this condition as it is a curable condition mimicking malignancy and can avoid unnecessary interventions. Conclusion: Pseudo-Meig’s syndrome associated with pericardial effusion is a rarely reported entity which can mimic malignant condition and hence it is important to consider it as a possibility in patients who present with pericardial effusion of unknown cause.