Caput Medusae

What is caput medusae?

Caput medusae is the appearance of enlarged or swollen veins across the front of your abdomen (belly). The name is Latin for “head of Medusa”. The veins appear to radiate out from your navel (belly button) like snakes from Medusa’s head. Sometimes, caput medusae is also called the “palm tree sign”.

If you notice bulging veins in the general area of your belly button (periumbilical veins), even if you don’t see a pattern like a palm tree or Medusa’s head, it might be caput medusae. Some veins may stick out more than others. These enlarged veins are a symptom of an underlying condition that needs attention.

What does it mean if I have caput medusae?

Veins on the surface of your abdomen enlarge when your circulatory system diverts extra blood flow through them. This is called collateral circulation. It means that these veins have become backup routes for blood that couldn’t flow through its normal channels. These channels are obstructed in some way.

What causes caput medusae?

The most common cause of caput medusae is portal hypertension, which means high blood pressure in your portal vein. Your portal vein is one of the major blood vessels carrying blood through your abdomen. Hypertension in this vein means that something is obstructing the blood flow through it.

Portal hypertension is most often a side effect of late-stage liver disease. This means it’s scarring in your liver (cirrhosis) that’s obstructing your portal vein. Your portal vein passes through your liver on its way to meet your inferior vena cava (IVC), the vein that carries blood from your lower body back to your heart.

Sometimes, it’s an obstruction in your inferior vena cava that leads to caput medusae. Your healthcare provider may refer to this as inferior vena cava syndrome. Blood clots, a tumor or a congenital abnormality of the blood vessels (such as Budd-Chiari syndrome) may obstruct your inferior vena cava.

What happens in caput medusae?

When blood backs up in these major vessels in your abdomen, it builds pressure inside of them. Your circulatory system works to relieve the pressure by diverting some of the blood into smaller channels. It’s like when cars stuck in traffic on the freeway get off at the nearest exit to take the back roads.

These narrow back roads aren’t designed for the same traffic that freeways are. If a lot of traffic diverts to these roads, they soon become clogged, too. Traffic may be moving now, but the roads look unnaturally congested. In your circulatory system, these back roads are called collateral veins.

Swollen collateral veins in your abdomen produce the appearance of caput medusae. They now look like varicose veins, with bulges and knots of backed-up blood, sometimes with a blueish color. Depending on the root cause, you may also have other collateral veins in other places along with caput medusae.

What other sites in my body might have enlarged collateral veins?

If you have caput medusae due to inferior vena cava syndrome, you might also see swollen veins around your waist or in your legs. If you have caput medusae due to portal hypertension, you might have enlarged veins on the inside of your stomach, rectum or esophagus. A healthcare provider will check for these.

What other symptoms might I have?

Whether you have portal hypertension or inferior vena cava syndrome, you’ll likely have other symptoms along with caput medusae. Many of these symptoms overlap between the two conditions.

With caput medusae, you might also have:

• Swollen legs and feet (edema).
• Swollen stomach (ascites).
• Abdominal pain.
• Enlarged liver that sticks out and feels hard.

In more severe cases, you might have:

• Confusion or disorientation (hepatic encephalopathy).
• Shortness of breath.
• Low urine output.
• Bloody vomit.

How can I tell which condition is causing my caput medusae?

You might have specific symptoms of liver cirrhosis with underlying portal hypertension, like:

• Jaundice.
• Itchy skin.
• Dark colored pee.
• Light-colored poop.
• Spidery red vessels on the chest and upper body (spider angiomas)

Or you might have symptoms of a deep vein thrombosis (DVT) that could be obstructing your IVC, like:

• Sudden swelling in one spot.
• A spot that looks red or darker than usual and/or feels warm.

A healthcare provider can often tell which condition you have by looking at your blood flow on an ultrasound. If the blood in your enlarged abdominal veins is flowing down toward your legs, you probably have cirrhosis. If it flows up to your heart, you might have inferior vena cava syndrome.

What is the treatment for caput medusae?

You probably won’t need treatment for caput medusae itself, but you’ll need treatment for the condition causing it. If the cause is acute — a removable, temporary blockage — the priority will be to remove it. If the cause is a chronic disease, you’ll need specific treatment for that disease.

If portal hypertension is causing complications besides caput medusae, your healthcare provider may treat portal hypertension directly. This is separate from the treatment for liver disease. They might do this, for example, if you have enlarged veins in your esophagus or GI tract that are prone to bleeding.

Procedures to redirect blood flow through your portal venous system include:

• Transjugular intrahepatic portosystemic shunt (TIPS): Guided by X-ray, a healthcare provider uses a needle to tunnel through your liver and connect your portal vein with one of your liver veins, diverting blood flow and relieving pressure. They place a stent to keep the tunnel open.
• Distal splenorenal shunt (DSRS): This surgical procedure might be a better fit for some people. A surgeon disconnects your splenic vein from your liver and diverts it to your left kidney vein instead, selectively reducing blood flow and pressure through both your liver and your spleen.

What are the risks of not seeking treatment for caput medusae?

Don’t ignore this symptom. While there are several possible causes, they’re all serious. Untreated portal hypertension can lead to life-threatening complications, including hepatopulmonary syndrome (respiratory failure) and hepatorenal syndrome (kidney failure). Untreated cirrhosis leads to liver failure.

Can caput medusae be prevented?

Caput medusae is often a symptom of a chronic disease that’s been with you for some time. Keeping up with your routine checkups can help bring these diseases to light sooner. With earlier recognition and treatment, you might be able to prevent them from progressing far enough to cause caput medusae.

A note from Cleveland Clinic

Caput medusae is a serious symptom. Something’s obstructing one of the major veins running through your abdomen, redirecting the blood flow to these surface veins. While the swollen veins you see aren’t likely to cause complications, the condition causing them will. If you see this sign, seek care right away.