Step I Thoracoepigastric Vein and Caput Medusae

[sab3156]

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Firecracker says this:

The portal vein is connected to the thoracoepigastric vein via the paraumbilical veins. Dilation of the thoracoepigastric and paraumbilical veins as a result of portal hypertension is what causes the characteristic finding of caput medusae (superficially dilated veins surrounding the umbilicus).


What exactly is the thoracoepigastric vein and what is its relevance to the superficial epigastric veins (which are dilated in caput medusae)?? First Aid 2017's diagram with the portosystemic anastomses doesn't label any thoracoepigastric vein.

 

[Anti-PD1]

Superficial epigastric vv. -> paraumbilical vv. -> thoracoepigastric vv. That's the order of drainage.

Importantly, the thoracoepigastric vein makes a connection between the femoral vein, the axillary vein, and the portal vein (via the paraumbilical veins). So it connects the IVC, the SVC and the portal vein. If the portal vein pressure is high for any reason (cirrhosis, liver failure), venous blood backs up into the superficial epigastric, paraumbilical and thoracoepigastric veins causing caput medusae.

 

[sab3156]

Wow, thanks. Your explanation is great. Makes a lot more sense now.