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 Table of Contents  
LETTER TO EDITOR
Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 440-441

Portal hypertension – Paraumbilical vein collaterals causing a medusa head appearance


Department of Radio-Diagnosis, JNMC, Wardha, Maharashtra, India

Date of Submission26-Nov-2019
Date of Decision10-Dec-2019
Date of Acceptance15-Dec-2019
Date of Web Publication16-Jul-2020

Correspondence Address:
Dr. Suresh Phatak
Department of Radio-Diagnosis, JNMC, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdmimsu.jdmimsu_188_19

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How to cite this article:
Manoj M, Phatak S, Lohchab P, Marfani G. Portal hypertension – Paraumbilical vein collaterals causing a medusa head appearance. J Datta Meghe Inst Med Sci Univ 2019;14:440-1

How to cite this URL:
Manoj M, Phatak S, Lohchab P, Marfani G. Portal hypertension – Paraumbilical vein collaterals causing a medusa head appearance. J Datta Meghe Inst Med Sci Univ [serial online] 2019 [cited 2020 Aug 11];14:440-1. Available from: http://www.journaldmims.com/text.asp?2019/14/4/440/289848



Sir,

We present ultrasonographic (USG) and Doppler findings of the paraumbilical vein causing medusa head appearance in a case of portal hypertension. A 40-year-old man, a suspected case of liver cirrhosis, presented with complaints of fatigue and abdominal pain. On examination, he was found to have abdominal wall varices around the umbilicus. On USG and Doppler abdomen, he showed features of portal hypertension in the form of hepatopedal flow in the portal and splenic vein and multiple portosystemic collaterals. Dilated (6 mm diameter) paraumbilical vein collateral was seen in the left lobe of the liver, with hepatofugal flow extending to the umbilical region being noted [Figure 1].
Figure 1: Clinical photograph of the patient showing medusa head appearance

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The paraumbilical vein arises from the left portal vein between the lateral and medial segments of the left hepatic lobe and courses along the anterior edge of the falciform ligament. On cross-sectional imaging, paraumbilical collateral number and course vary and they appear as tubular structures more than 2–3 mm in diameter and usually anastomose with the superior epigastric or internal thoracic veins or inferior epigastric vein and drain into superior vena cava or inferior vena cava, respectively.[1] Occasionally, the paraumbilical vein drains into the abdominal veins, creating a “medusa's head” appearance. The paraumbilical system is a frequent abdominal portosystemic pathway, with reported prevalence of 30%–35%.[2],[3] Addition of Doppler imaging to conventional sonography significantly increases the sensitivity for diagnosis of portal hypertension by the demonstration of a paraumbilical vein.[4] A significantly enlarged paraumbilical vein on duplex Doppler ultrasound in cirrhotics may have important hemodynamic consequences, besides predisposing patients to portosystemic encephalopathy; it may also offer some protection against the formation of large varices [Figure 2] and [Figure 3].[5],[6],[7],[8],[9],[10],[11],[12],[13]
Figure 2: Dilated paraumbilical vein in the left lobe of liver (6 mm)

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Figure 3: Color Doppler image showing multiple dilated veins around umbilicus a part of medusa head appearance

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Morin C, Lafortune M, Pomier G, Robin M, Breton G. Patent paraumbilical vein: Anatomic and hemodynamic variants and their clinical importance. Radiology 1992;185:253-6.  Back to cited text no. 1
    
2.
Cho KC, Patel YD, Wachsberg RH, Seeff J. Varices in portal hypertension: Evaluation with CT. Radiographics 1995;15:609-22.  Back to cited text no. 2
    
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Subramanyam BR, Balthazar EJ, Madamba MR, Raghavendra BN, Horii SC, Lefleur RS. Sonography of portosystemic venous collaterals in portal hypertension. Radiology 1983;146:161-6.  Back to cited text no. 3
    
4.
Gibson RN, Gibson PR, Donlan JD, Clunie DA. Identification of a patent paraumbilical vein by using Doppler sonography: Importance in the diagnosis of portal hypertension. AJR Am J Roentgenol 1989;153:513-6.  Back to cited text no. 4
    
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Gupta D, Chawla YK, Dhiman RK, Suri S, Dilawari JB. Clinical significance of patent paraumbilical vein in patients with liver cirrhosis. Dig Dis Sci 2000;45:1861-4.  Back to cited text no. 5
    
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Gaikwad KB, Joshi NG, Selkar SP. Study of Nitrosative Stress in 'Pregnancy Induced Hypertension. J Clin Diagn Res 2017;11:BC06–8. Available from: https://doi.org/10.7860/JCDR/2017/23960.9396. [Last accessed on 2019 Nov 22].  Back to cited text no. 8
    
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Agarwal NK, Trivedi S. The Partial Pressure of Oxygen in Arterial Blood: A Relation with Different Fraction of Inspired Oxygen and Atmospheric Pressures. J Datta Meghe Inst Med Sci Univ 2017;12:280-3. Available from: https://doi.org/10.4103/jdmimsu.jdmimsu_31_18. [Last accessed on 2019 Nov 22].  Back to cited text no. 9
    
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Khatib M, Sinha A, Gaidhane A, Simkhada P, Behere P, Saxena D, et al.A systematic review on effect of electronic media among children and adolescents on substance abuse. Indian Journal of Community Medicine. 2018;43:S66-72. Available from: https://doi.org/10.4103/ijcm.IJCM_116_18. [Last accessed on 2019 Nov 22].  Back to cited text no. 10
    
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Khatib MN, Kirubakaran R, Gaidhane S, Shankar AH, Quazi Syed Z. Yoga for improving functional capacity, quality of life and cardiovascular outcomes in people with heart failure. Cochrane Database Syst Rev [Internet].2017;2017. Available from: https://doi.org/10.1002/14651858.CD012015.pub2. [Last accessed on 2019 Nov 22].  Back to cited text no. 11
    
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Kirnake V, Arora A, Sharma P, Goyal M, Chawlani R, Toshniwal J, et al. Non-Invasive Aspartate Aminotransferase to Platelet Ratio Index Correlates Well with Invasive Hepatic Venous Pressure Gradient in Cirrhosis. Indian J Gastroenterol 2018;37:335-41. Available from: https://doi.org/10.1007/s12664-018-0879-0. [Last accessed on 2019 Nov 22].  Back to cited text no. 12
    
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Kumar S, Bhayani P, Hathi D, Bhagwati J. Hyponatremia Initial Presenting Feature of Normal Pressure Hydrocephalus in Elderly Patient: A Rare Case Report. J Gerontol Geriatr 2018;l66:156-7.  Back to cited text no. 13
    


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