Starry sky pattern of fetal liver sonogram as first sign of twin-twin transfusion syndrome

Ultrasound in Obstetrics & Gynecology, 04/27/2012

The authors present a case in which the sonographic appearance of starry sky liver, along with right–sided cardiac failure (tricuspid regurgitation), were the first signs of twin–to–twin transfusion syndrome (TTTS) in monochorionic twins at 20 weeks. A short time later, at 21 weeks, other signs of overload and signs of worsening heart failure were noted, as the typical triphasic waves in the inferior vena cava were replaced by a biphasic flow profile.

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