An elderly woman with a history of alcoholism presents to
the clinic with the engorged abdominal veins pictured. What is this
presentation called and what is the most likely etiology?
Engorged veins forming a knot in the area of the umbilicus are described as “caput medusae.” Given this woman’s medical history, this presentation is likely secondary to liver cirrhosis with subsequent portal hypertension and development of circulation circumventing the liver. The veins of the lower abdominal wall normally drain inferiorly to the iliofemoral system, while the veins of the upper abdominal wall drain superiorly into the veins of the chest wall and axilla. When portal hypertension occurs due to cirrhosis, the umbilical vein, normally obliterated early in life, may recanalize. Blood from the portal venous system may be shunted to the abdominal wall veins, causing them to become prominent.
Text Source: The Atlas of Emergency Medicine, 3e. Chapter 7. Chest and Abdomen – Caput Medusae. & UptoDate: Cirrhosis in adults: Etiologies, clinical manifestations, and diagnosis.
Image Source: The Atlas of Emergency Medicine, 3e. Chapter 7. Chest and Abdomen, Figure 7.36.
Engorged veins forming a knot in the area of the umbilicus are described as “caput medusae.” Given this woman’s medical history, this presentation is likely secondary to liver cirrhosis with subsequent portal hypertension and development of circulation circumventing the liver. The veins of the lower abdominal wall normally drain inferiorly to the iliofemoral system, while the veins of the upper abdominal wall drain superiorly into the veins of the chest wall and axilla. When portal hypertension occurs due to cirrhosis, the umbilical vein, normally obliterated early in life, may recanalize. Blood from the portal venous system may be shunted to the abdominal wall veins, causing them to become prominent.
ReplyDeleteText Source: The Atlas of Emergency Medicine, 3e. Chapter 7. Chest and Abdomen – Caput Medusae. & UptoDate: Cirrhosis in adults: Etiologies, clinical manifestations, and diagnosis.
Image Source: The Atlas of Emergency Medicine, 3e. Chapter 7. Chest and Abdomen, Figure 7.36.