What is the significance of spider angioma (nevus)?

From the Guidelines

Spider angioma is a significant clinical finding associated with liver disease, particularly cirrhosis and portal hypertension.

Clinical Significance

• Spider angiomas are often seen in patients with cirrhosis, especially those with a history of alcohol abuse 1
• They can also be present in patients with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) 1
• The presence of spider angiomas, along with other signs such as palmar erythema and jaundice, can indicate advanced liver disease and portal hypertension 1

Diagnostic Considerations

• Spider angiomas are not specific to liver disease and can be seen in other conditions, such as pregnancy 1
• A thorough physical examination and laboratory tests, including liver function tests and imaging studies, are necessary to diagnose liver disease and portal hypertension 1
• The presence of spider angiomas should prompt further evaluation for underlying liver disease and portal hypertension, especially in patients with a history of alcohol abuse or other risk factors for liver disease 1

From the Research

Significance of Spider Angioma

The significance of spider angioma, also known as nevus, can be understood through its association with various medical conditions. Some key points to consider are:

• Spider angiomas are dilated vascular channels in the skin, often associated with liver cirrhosis, thyrotoxicosis, and pregnancy 2.
• They are characterized by a central arteriole with surrounding vascular channels resembling the legs of a spider, and are frequently found in the territory of the superior vena cava, including the face, upper chest, and arms 2, 3.
• The presence of spider angiomas can be an indicator of underlying liver disease, with a specificity of 95% in patients with liver cirrhosis 2.
• The prevalence of spider angiomas in cirrhosis is reported to be around 30-40%, although this can vary depending on the study and population 2, 3.

Association with Liver Disease

The relationship between spider angiomas and liver disease is well-established. Some key findings include:

• Spider angiomas are more common in patients with liver cirrhosis, particularly those with a history of alcoholism and impaired liver function 4.
• The presence of spider angiomas has been associated with a higher risk of mortality in patients with chronic liver disease, although more research is needed to determine the prognostic importance of the number and location of spider angiomas 5.
• The underlying pathogenesis of spider angiomas in cirrhosis is multifactorial, including decreased levels of testosterone and high levels of estradiol, hyperdynamic circulation, and high levels of substance-P and vascular endothelial growth factor leading to angiogenesis and vasodilation 2.

Clinical Implications

The clinical implications of spider angiomas are significant, particularly in patients with underlying liver disease. Some key points to consider are:

• Spider angiomas can be a useful diagnostic tool in patients with suspected liver disease, particularly when combined with other clinical and laboratory findings 2, 3.
• The presence of spider angiomas can also be an indicator of the severity of liver disease, with more numerous and larger spider angiomas often associated with more advanced disease 5, 4.
• Treatment of spider angiomas typically involves addressing the underlying cause, such as liver disease, although other treatments such as hand or ice compressions and cyanoacrylate glue injection may be used in certain cases 2.