Caput medusae

For the cactus, see Astrophytum caput-medusae.

Caput medusae
Axial CT showing portosystemic collateral circulation via the umbilical vein: caput medusae in liver cirrhosis
Classification and external resources
Specialty	cardiology
ICD-10	I86.8 (ILDS I86.820)

Caput medusae, also known as palm tree sign, is the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen. The name caput medusae (Latin for "head of Medusa") originates from the apparent similarity to Medusa's head, which had venomous snakes in place of hair. It is also a symptom of portal hypertension. It is caused by dilation of the paraumbilical veins, which carries oxygenated blood from mother to fetus in utero and normally closes within one week of birth, becoming re-canalised due to portal hypertension caused by liver failure.

Differential diagnosis

Inferior vena cava obstruction

Produces abdominal collateral veins to bypass the blocked inferior vena cava and permit venous return from the legs.

How to differentiate

Determine the direction of flow in the veins below the umbilicus. After pushing down on the prominent vein, blood will:

flow toward the legs -> caput medusae
flow toward the head-> inferior vena cava obstruction.

Arteriosclerosis	Atherosclerosis Foam cell Fatty streak Atheroma Intermittent claudication Critical limb ischemia Monckeberg's arteriosclerosis Arteriolosclerosis Hyaline Hyperplastic Cholesterol LDL Oxycholesterol Trans fat

Stenosis	Carotid artery stenosis Renal artery stenosis

Other	Aortoiliac occlusive disease Degos disease Erythromelalgia Fibromuscular dysplasia Raynaud's phenomenon

Aneurysm / dissection /
pseudoaneurysm

Vascular malformation

Vascular nevus

Veins

Inflammation	Phlebitis

Venous thrombosis / Thrombophlebitis	primarily lower limb Deep vein thrombosis abdomen Hepatic veno-occlusive disease Budd–Chiari syndrome May–Thurner syndrome Portal vein thrombosis Renal vein thrombosis upper limb / torso Mondor's disease Paget–Schroetter disease head Cerebral venous sinus thrombosis Post-thrombotic syndrome

Varicose veins	Gastric varices Portacaval anastomosis Caput medusae Esophageal varices Hemorrhoid Varicocele

Other	Chronic venous insufficiency Chronic cerebrospinal venous insufficiency Superior vena cava syndrome Inferior vena cava syndrome Venous ulcer

Arteries or veins

Blood pressure

Hypertension	Hypertensive heart disease Hypertensive emergency Hypertensive nephropathy Essential hypertension Secondary hypertension Renovascular hypertension Benign hypertension Pulmonary hypertension Systolic hypertension White coat hypertension

Hypotension	Orthostatic hypotension

This article is issued from Wikipedia - version of the 11/8/2016. The text is available under the Creative Commons Attribution/Share Alike but additional terms may apply for the media files.

Caput medusae

Differential diagnosis

Inferior vena cava obstruction

How to differentiate

See also