Journal of Datta Meghe Institute of Medical Sciences University

: 2019  |  Volume : 14  |  Issue : 4  |  Page : 440--441

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

Correspondence Address:
Dr. Suresh Phatak
Department of Radio-Diagnosis, JNMC, Sawangi (Meghe), Wardha - 442 001, Maharashtra

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;14:440-441

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 2021 Mar 1 ];14:440-441
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Full Text


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}

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}{Figure 3}

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.

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Conflicts of interest

There are no conflicts of interest.


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