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Unusual abdominal collateral vein circulation


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Hi.

Today I've examined a 20 hours of life, male, with some kind of abdominal collateral circulation, but no hepatosplenomegally or massa. No other abnormal findings on physical exam.

He was delivered at 40 weeks by a 25 year old gravida 2 para 1 woman with negative serologic findings (CMV not tested). The neonate was delivered vaginally and had APGAR scores of 8-9, and was transfered to Well Baby Nursery.

Would tou think about some specific condition? Any tests? I've never seen such finding in a infant without liver failure... Is It possible to be normal?

Thank you!

 

IMG-20210902-WA0000.jpg

IMG-20210902-WA0001.jpg

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This looks unusual indeed, have not seen this before.

I would recommend an echocardiography and a regular ultrasound of the abdominal organs to start with, to look for any apparent anomalies in the "venous geography". If those investigations turns out to be normal, I really don't know. I suppose we would offer clinical followup and wait and see.

Will follow this topic with great interest!

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Interesting case - looks like Caput Medusae in adults - caused by portal hypertension and dilation of the paraumbilical veins.
Could be due to portal hypertension, but not fulminant liver failure?

I have seen one child with portal hypertension secondary to umbilical vein thrombosis (probably secondary to umbilical vein catheter), but he presented in young school age.

Our plan would probably be something like what Stefan describes - maybe ultrasound with contrast.

Attached is a case report with neonatal caput medusa - disappeared within the first months of life.

molad2018.pdf

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Hello. I'm agree, it's a very interesting case to learn so much.

Caput medusae is a rare neonatal finding.

• Primary or secondary Budd-Chiari syndrome should be excluded in the neonatal period.

• In contrast to adults with caput medusae from portal hypertension, this collateral abdominal circulation can be a benign variant.

• If cardiac or venous malformations are ruled out, an expectant approach is indicated because the collateral veins will gradually involute in the first weeks after birth without sequelae.

neoreview.soares2020.pdf

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Hi!

Thank you all for trying to help. It's the first time I use this forum. It's very good to finelly find a place where we can share experiences and make some questions with neonatologists all over the world.

The baby remains well appearing. We perform an echo and an abdominal ultrassound, both normal (none evidence of abnormal IVC anatomy or portal hypertension). He was discharged at 60 hours of life and is scheduled for follow up appointment in 4 weeks.

I'll keep in touch!

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