What is caput medusae?

Caput medusae, sometimes called a palm tree sign, refers to the appearance of a network of painless, swollen veins around your bellybutton. While it’s not a disease, it is a sign of an underlying condition, usually liver disease.

Due to better techniques for diagnosing liver disease in its earlier stages, caput medusae is now rare.

What are the symptoms?

The main symptom of caput medusae is a network of large, visible veins around the abdomen. From a distance, it might look like a black or blue bruise.

Caput Medusae

Other symptoms that might accompany it include:

  • swollen legs
  • an enlarged spleen
  • larger breasts in males

If you have advanced liver disease, you may also notice the following symptoms:

  • abdominal swelling
  • jaundice
  • mood changes
  • confusion
  • excessive bleeding
  • spider angioma

What causes it?

Caput medusae is almost always caused by portal hypertension. This refers to high pressure in your portal vein. The portal vein carries blood to your liver from your intestines, gall bladder, pancreas, and spleen. The liver processes the nutrients in the blood and then sends the blood along to the heart.

Caput medusae are usually related to liver disease, which eventually causes liver scarring or cirrhosis. This scarring makes it harder for blood to flow through the veins of your liver, leading to a backup of blood in your portal vein. The increased blood in your portal vein leads to portal hypertension.

With nowhere else to go, some of the blood tries to flow through nearby veins around the belly button, called the periumbilical veins. This produces the pattern of enlarged blood vessels known as caput medusae.

Other possible causes of liver disease that would lead to portal hypertension include:

  • hemochromatosis
  • alpha 1-antitrypsin deficiency
  • hepatitis B
  • chronic hepatitis C
  • alcohol-related liver disease
  • fatty liver disease

In rare cases, a blockage in your inferior vena cava, a large vein that carries blood from your legs and lower torso to your heart, can also cause portal hypertension.

How is it diagnosed?

Caput medusae are usually easy to see, so your doctor will likely focus on determining whether it’s due to liver disease or a blockage in your inferior vena cava.

A CT scan or ultrasound can show the direction of blood flow in your abdomen. This will help your doctor narrow down the cause. If the blood in the enlarged veins is moving toward your legs, it’s likely due to cirrhosis. If it’s flowing up toward your heart, a blockage is more likely.

How is it treated?

While caput medusae itself doesn’t require treatment, the underlying conditions that cause it to do.

Caput medusae is usually a sign of more advanced cirrhosis, which requires immediate treatment. Depending on the severity, this can include:

  • implanting a shunt, a small device that opens up the portal vein to reduce portal hypertension
  • medications
  • liver transplant

If caput medusa is due to a blockage in your inferior vena cava, you’ll likely need emergency surgery to fix the blockage and prevent other complications.

What’s the outlook?

Thanks to improved methods for detecting liver disease, caput medusae is rare. But if you think you’re showing signs of caput medusae, contact your doctor as soon as possible. It’s almost always a sign of something that needs immediate treatment.

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