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Caput medusae sign - portal hypertension

Case contributed by Mohammad Taghi Niknejad
Diagnosis almost certain

Presentation

Abdominal pain.

Patient Data

Age: 50 years
Gender: Male

Mild modularity of the liver parenchyma without an obvious mass. The portal vein and its main branches are dilated. Distended and engorged veins in the at anterior mid line abdominal wall, which are seen radiating from the abdominal wall across the abdomen to join the systemic veins (Caput medusae sign) indicative of portal hypertension.

Splenomegaly.  Small volume ascites.

The intra- and extrahepatic bile ducts are of normal caliber. The gallbladder is of normal volume containing an 11mm stone.

 

Case Discussion

The caput medusae sign is seen in patients with severe portal hypertension. It describes the appearance of distended and engorged paraumbilical veins, which are seen radiating from the umbilicus across the abdomen to join the systemic veins. 

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