Caput medusae

Caput Medusae is characterised by the appearance of dilated veins spreading from the umbilicus (belly button), resembling the head of Medusa from Greek mythology. This is due to blood finding alternative pathways to flow in the abdomen, causing swelling in the veins on the abdomen. It can be due to conditions like cirrhosis, portal hypertension (where liver damage leads to increased pressure in the portal vein) and chronic alcohol liver disease.

• Vascular

  Hepatic Veno-occlusive Disease (blockage to the hepatic vein) [1]

• Infection

  Schistosomiasis [2]

  Viral hepatitis [3]

• neoplasm

  Superior vena cava obstruction secondary to lung cancer [4]

• Drugs

  Methotrexate [5]

  Azathioprine [6]

  Vincristine [7]

• Iatrogenic

  Surgical procedures that damage the hepatic vein causing portal hypertension

• congenital

  Budd-Chiari Syndrome [8]

• autoimmune

  Hemochromatosis [9]

  Alpha 1-antitrypsin deficiency [10]

  Hepatitis B

  Chronic hepatitis C [11]

• trauma

  Chronic alcohol liver disease [12]

• endocrine/metabolic

  Liver cirrhosis [12]

Source: BMJ Case Rep. 2010 [13]

Caput medusae 

Dilated superficial epigastric veins spreading from a central large vein 

Source: North England Journal Med [14]

Caput medusae

Dilated veins located around the umbilicus

Source: Medizzy; creds:

Jafar Aziz [15]

Caput medusae 

Severe caput medusae with dilated veins spread from the umbilicus to the superior regions of the abdomen

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8076947/

[2] https://www.semanticscholar.org/paper/Caput-Medusae-due-to-portal-hypertension-in-Santos/7faa426376a2cc87ffee0b6f4c3bd34f96193865

[3] https://www.sciencedirect.com/science/article/abs/pii/B9780323376761500807

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911767/#:~:text=Caput%20medusae%20are%20venous%20dilatations,umbilical%20to%20the%20cranial%20direction.

[5] https://www.ncbi.nlm.nih.gov/books/NBK548219/

[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8100374/

[7] https://www.ncbi.nlm.nih.gov/books/NBK547989/#:~:text=Both%20vincristine%20and%20vinblastine%20may,when%20given%20on%20their%20own.

[8] https://casereports.bmj.com/content/14/4/e242076

[9] https://link.springer.com/article/10.1007/BF02232679

[10] https://www.ncbi.nlm.nih.gov/books/NBK554597/

[11] https://www.nhs.uk/conditions/hepatitis-b/

[12] https://accessemergencymedicine.mhmedical.com/content.aspx?bookid=2969&sectionid=250456775

[13] https://casereports.bmj.com/content/2010/bcr.03.2010.2795

[14] https://www.nejm.org/doi/full/10.1056/nejmicm050651

[15] https://medizzy.com/feed/6119221