Caput medusa

Case contributed by Chris O'Donnell
Diagnosis certain


Incidental finding in a patient with sudden, severe abdominal pain.

Patient Data

Age: 70 years
Gender: Male

Features of cirrhosis and portal hypertension with multiple venous collaterals especially around the spleen (portosystemic shunts).  Recannalized paraumbilical vein entering an umbilical hernia containing fat.

Annotated image

Caput medusa (i.e. leash of abnormal veins).

Case Discussion

Caput medusa (head of Medusa with multiple serpent-like veins in the umbilicus) reflects portal hypertension with the umbilicus being the end point for the recanalized paraumbilical vein (in this case highlighted by the fat-containing umbilical hernia).  These veins are at higher pressure than normal thus are prone to hemorrhage with minimal trauma.  Indeed in some cases, this can be fatal due to the associated coagulopathy of chronic liver disease.

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