Caput medusae

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For the cactus, see Astrophytum caput-medusae.
Caput medusae
Caput medusae CT ax 002.jpg
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)
ICD-9-CM 456.8

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[edit]

Inferior vena cava obstruction[edit]

How to differentiate[edit]

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.

See also[edit]