This patient had distended umbilical veins (caput medusae) and chylous ascites due to malignancy (metastatic pancreatic NET). Don't forget to check ascitic triglycerides and cytology + imaging if you see this milky colour. Infographic: @NEJM Case:https://proceedings.med.ucla.edu/wp-content/uploads/2019/06/Lazarus-A190422ML-BLM-edited.pdf