β Scribed by Tim J. White; Philip V. Kaye; Linda Morgan; Dileep N. Lobo
No coin nor oath required. For personal study only.
Portal hypertension often produces a myriad of collateral vessels, which, in turn, are accompanied by a wealth of eponyms. Cruveilhier-Baumgarten either refers to a disease state in which the umbilical vein remains patent after birth, or a syndrome in which the umbilical vein is recanalized as a collateral because of portal hypertension (from cirrhosis). The sign of Cruveilhier-Baumgarten refers to the venous hum heard over the umbilicus, or a caput medusae that arises from hepatofugal flow through the recanalized umbilical vein. It is a tribute to the classical education of the early anatomists that they saw the snakes that made up Medusa's hair in the tortuous ramifications of the collaterals surrounding the umbilicus. Sappey described the paraumbilical veins of the accessory portal system, which drain the falciform ligaments and surrounding areas to join the peripheral portal branches in the left hepatic lobe, the internal mammary veins, the diaphragmatic veins, and branches of the inferior epigastric veins around the umbilicus. What is the importance of all this? Only recognition that detection of such veins, whether by careful physical examination or by sophisticated imaging studies, means portal hypertension and probably cirrhosis. Examine the caput medusae carefully without fear of being turned to stone as humans were when they gazed upon the face of the chthonic Gorgon, Medusa.
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