Caput Medusae ("head of Medusa") describes distended vessels around the umbilicus seen in patients with portal hypertension, often related to cirrhosis of the liver. The term is ascribed to Marco Aurelia Severino (1580-1656).


Synonym: cirsomphalos


The umbilicus serves as the head of Medusa, and distended superficial veins radiating out from the umbilicus comprise the snakes. Superiorly the drainage is to axillary veins and inferiorly to the femoral veins. Sometimes only the superior or inferior draining veins are distended.


If there is portal hypertension bloo in the left portal vein enters the paraumbilical vein in the falciform ligament and reaches the periumbilical veins.


Imaging studies may be able to demonstrate the vascular changes before they are clinically evident.


Differential diagnosis:

(1) vascular malformation at the umbilicus

(2) infection of the umbilicus with prominent lymphatics


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