Veins of the abdomen normally are scarcely visible within the abdominal wall. Engorged veins, however, are often visible through the normal abdominal wall. Engorged veins forming a knot in the area of the umbilicus are described as caput medusae. The extent of associated findings depends on the underlying etiology. It is usually secondary to liver cirrhosis, with subsequent portal hypertension and development of circulation circumventing the liver.
Management and Disposition
Treatment is directed at the underlying cause. This finding by itself does not require acute treatment.
Caput medusae have the same clinical significance as the more common patterns of venous engorgement.
If pressure on a prominent abdominal wall vein results in flow of blood to the head, the likely cause is inferior vena cava obstruction. If the flow is to the feet, it is caput medusa.
Caput Medusae. This elderly female with alcoholic cirrhosis has engorged abdominal veins in the knotted appearance consistent with caput medusae. (Photo contributor: Gary Schwartz, MD.)