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Case of the Month

January 2010

Patient Data: 2 male patients age 64 and 71

Clinical Info: Both patients have a palpable lesion in the abdominal wall near the umbilicus. One shows a slight blue discoloration. An ultrasound examination was requested to confirm an umbilical hernia.


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Transverse image of the lesion in patient 1


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Transverse image of the lesion in patient 2. Can you guess what the lesion is and what is the underlying problem?


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Longitudinal image of the lesion in patient 2. You have probably noticed that both lesions are no umbilical hernias, but look like dilatated vascular structures.


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Longitudinal color Doppler image of the lesion of patient 2. There is flow and there is a vessel entering and leaving the lesion.


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Transverse color Doppler image of the lesion of patient 1 also showing flow. Both lesions represent a herniating paraumbilical vein varix. Did you notice the vessel directly underneath the abdominal wall?


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The Doppler spectrum confirms the venous nature of the lesion in patient 1.


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Longitudinal image of the vein underneath the abdominal wall of patient 1. Can you guess where the vein is coming from?


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Longitudinal image of the upper abdomen of patient 2. There is also a vein running underneath the abdominal wall.


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Longitudinal color Doppler image of patient 2. The vein can be followed all the way to the liver.


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Transverse image of patient 2 showing the vein in relation to the liver. In both patients the venous structure in the upper abdomen represents a recanalized umbilical vein or a widened paraumbilical vein. A recanalized umbilical or a widened paraumbilical vein can be found in patients with liver disease and portal hypertension. Patency of this vein is found in 9 percent of patients with portal hypertension. It serves as a hepatofugal collateral. In the literature there is discussion whether the vein actually represents the recanalized umbilical vein or a widened paraumbilical vein.


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Longitudinal image of the left liver lobe of patient 2 showing a hyperechoic liver with an irregular contour.


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Longitudinal image of the right liver lobe of patient 1 showing the same features. Both patients have a cirrhotic liver.


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Anechoic structure in the abdominal wall in the umbilical region

In patients with liver cirrhosis it is important to look for other signs of portal hypertension. Both patients also had a splenomegaly as shown here on this longitudinal image of patient 1 showing an 18 cm large spleen.

For more examples of liver cirrhosis, portal hypertension and (para)umbilical veins see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.