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| LETTER TO EDITOR |
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| Year : 2019 | Volume
: 14
| Issue : 4 | Page : 440-441 |
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Portal hypertension – Paraumbilical vein collaterals causing a medusa head appearance
Megha Manoj, Suresh Phatak, Priya Lohchab, Gulam Marfani
Department of Radio-Diagnosis, JNMC, Wardha, Maharashtra, India
| Date of Submission | 26-Nov-2019 |
| Date of Decision | 10-Dec-2019 |
| Date of Acceptance | 15-Dec-2019 |
| Date of Web Publication | 16-Jul-2020 |
Correspondence Address:
Dr. Suresh Phatak
Department of Radio-Diagnosis, JNMC, Sawangi (Meghe), Wardha - 442 001, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdmimsu.jdmimsu_188_19
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 4];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 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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[Figure 1], [Figure 2], [Figure 3]
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