What is caput medusa?
Caput medusa is the appearance of distended, engorged spidery veins around the umbilicus.  These veins radiate from the umbilicus and give the lesion its name meaning “head of Medusa.”  These veins are a cutaneous manifestation of increased portal venous pressure that is a sign of severe portal hypertension.

What causes caput medusa?
Caput medusa forms due to shunting of blood from the liver circulation to the systemic circulation via the veins surrounding the umbilicus.  This shunting is not the normal route of blood flow in a healthy individual and is caused by increased liver pressures due to certain kinds of liver disease.  Increased liver pressures force the blood to drain through a new route via the paraumbilical veins.  The paraumbilical veins are not naturally equipped to receive such high volumes of blood so they become distended and engorged forming a sunburst pattern of vessels radiating around the umbilicus.

How is caput medusa treated?
Caput medusa can only be treated by managing the underlying medical condition, most likely cirrhosis or liver cancer.

Wolff K, Johnson, RA.  Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. Sixth Edition. 2009.