Practice Paper 6: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
In portal hypertension secondary to cirrhosis, the high pressure within the portal vein results in portosystemic shunting, i.e. flow of blood under high pressure into collateral veins such as the submucosal oesophageal veins, rectal veins and umbilical veins. Under higher than normal pressure, these veins become dilated, engorged and tortuous. Caput medusae is a sign of portal hypertension in which the umbilical veins become dilated and engorged and are seen to radiate from the umbilicus. A similar sign is also seen in inferior vena caval obstruction, and is differentiated from caput medusae by determining the flow of blood. In inferior vena caval obstruction, the blood flows towards the head in an attempt to bypass the blocked vessel. In caput medusae, the blood flows towards the legs. Portosystemic shunting is also responsible for the development of rectal varices and oesophageal varices in patients with portal hypertension.
Test Paper 4
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike in Get Through, 2017
Developmental venous anomalies (DVAs), also called venous angiomas, are variations of the normal veins that are necessary for the drainage of white and grey matter. They are associated with other vascular malformations like cavernoma. On contrast-enhanced CT, the venous collector of the DVA is readily detectable as a linear or curvilinear focus of enhancement, typically coursing from the deep white matter to a cortical or a deep vein or to the dural sinus. On MRI, DVAs typically have a transhemispheric flow void, on both T1-weighted and T2-weighted images. The collector vein is detected as a linear or small, round, signal-void structure on all sequences and is shown most clearly on T2-weighted imaging. On contrast-enhanced MRI, the cluster of veins in DVAs has a spoked wheel appearance; the veins are small at the periphery and gradually enlarge as they approach a central draining vein. This appearance has been referred to as caput medusae (or the ‘head of Medusa’).
C
Anton Sebastian in A Dictionary of the History of Medicine, 2018
Caput Medusae Where subcutaneous distension of veins over the abdomen becomes visible owing to cirrhosis. Named by a Roman state physician, Marcus Aurelius, in AD 160 It takes its origin from Medusa, the Greek mythical queen of the Gorgons whose head was covered with snakes. George Budd (1808–1882) of King’s College, London stated that ‘these veins answer a good purpose’ in 1845, implying that they served as collaterals. Marie Philibert Constant Sappey (1810–1896) of Paris demonstrated the collateral flow with illustrations in 1883.
The use of in vivo reflectance confocal microscopy for the diagnosis of melanoma
Published in Expert Review of Anticancer Therapy, 2019
Marina Agozzino, Elvira Moscarella, Graziella Babino, Stefano Caccavale, Vincenzo Piccolo, Giuseppe Argenziano
RCM can aid in the diagnostic process and can enhance the diagnostic accuracy compared to dermoscopy evaluation alone [43–46]. RCM epidermal features include the presence of numerous, widespread, pleomorphic dendritic melanocytes dispersed as individual units. These cells are initially in the basal layer of the epidermis, but extend along the epithelium of hair follicles (C) (Figure 3). Round pagetoid cells are more significant for the diagnosis of LM than dendritic ones, that are also observed in solar lentigo and actinic keratosis. Those cells are not located around annexe structures, and nesting is not present in benign lesions. Moreover, the presence of marked epidermal disarray, with loss of the rete-ridges and epidermal atrophy is frequently observed. When the lesion progresses, continuity of single-cell basilar melanocytic proliferation is observed, followed by a nested junctional pattern appearing as a ‘caput medusae’ due to elongated aggregates of dendritic melanocytes connected to the hair follicles [45]. In the phase of the dermal invasion, the presence of pagetoid spreading and nests are prevalent [45].
Role of developmental venous anomalies in etiopathogenesis of demyelinating diseases
Published in International Journal of Neuroscience, 2019
Siddika Halicioglu, Sule Aydin Turkoglu
Images were obtained with a 1.5 Tesla, Magnetom Symphony (Siemens, Germany) MRI device. T2-weighted images, axial and coronal postcontrasted T1-weighted images, and fluid attenuation inversion recovery (FLAIR) images were used in the assessment. The thickness of the sequences were 5 mm. 1 mmol/kg gadobutrol or 0. 2 mmol/kg gadodiamid, gadopentetic asid, gadoteric asid was given to each patient. Caput medusae and/or drainage were evaluated as DVA when seen in the axial and coronal views of the patient and confirmed by the patient’s follow-up examinations. The DVAs were also classified by location as juxtacortical, subcortical and deep, according to Valavanis et al [16]. Patients MRI examination were reviewed retrospectively by the same observer.
Prevalence and Nature of Structural Brain Abnormalities in Batterers: A Magnetic Resonance Imaging Study
Published in International Journal of Forensic Mental Health, 2019
Natalia Bueso-Izquierdo, Juan Verdejo-Román, José Pablo Martínez-Barbero, Miguel Ángel Pérez-Rosillo, Miguel Pérez-García, Natalia Hidalgo-Ruzzante, Stephen D. Hart
Images highly suspicious of developmental venous anomalies (DVAs, also known as caput medusae) were observed in one batterer. As intravenous contrast media was not administered, the diagnosis could not be confirmed. The suspected DVA was located at the inferior frontal gyrus. DVAs are congenital abnormalities of venous drainage that typically do not cause other symptoms and are without clinical significance (Töpper et al., 1999); in these cases, there was no suspicion of complications, as no oedema or bleeding was seen surrounding the suspected DVAs.
Related Knowledge Centers
- Inferior Vena Cava
- Portal Hypertension
- Abdomen
- Uterus
- Superficial Epigastric Vein
- Navel
- Paraumbilical Veins
- Liver Failure
- Leg
- Portacaval Anastomosis