IS Case 228: Caput Medusa

Daniel Ginat, MD, MS

Imaging Sciences URMC 2008
Publication Date: 2009-05-22


Patient is a 53-year-old-male with end stage liver disease.


Contrast-enhanced CT revealed prominent porto-systemic collateral vessels, including caput medusa.


Caput Medusa


Portal hypertension can lead to numerous porto-systemic collaterals, including coronary veins (most common), esophageal, paraumbilical, abdominal wall, perisplenic, omental, mesenteric, splenorenal, and gastrorenal varices, among others. On CT, these vessels can appear smooth, rounded, or tortuous. Their characteristic distributions and homogeneous enhancement with contrast administration helps differentiate them from lymph nodes, tumors, and loops of bowel.

Caput medusa consists of collateral veins that emanate from the subcutaneous tissues of the umbilicus. Caput medusa comprises branches of paraumbilical and omental veins leading to inferior and superior epigastric veins. Although varicosity of abdominal veins can be seen in up to 30% of patients with portal hypertension, caput medusa is considered a rare finding.


  1. Cho KC, Patel YD, Wachsberg RH, Seeff J. Varices in portal hypertension: evaluation with CT. Radiographics. 1995 May;15(3):609-22. [PMID: 7624566]

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