International Journal of Clinical & Medical Images

A 57-year old man with history of alcoholic cirrhosis was admitted with hepatic encephalopathy. Several stigmata of chronic liver disease including gynecomastia andmultiple giant spider neaviwere observed over his anterior and posterior thorax.

Spider nevi are arterial lesions consisting of a central arteriole with numerous small radiating vessels, resembling a spider’s legs. The central arteriole feed the branching vessels and therefore when pressure is applied on the central arteriole, the entire lesion blanches. Spider nevi are found in the vascular territory of the superior vena cava in chronic liver disease. Presence of spider nevi in a patient with liver disease increases the likelihood ratio of cirrhosis (LR: 4.3; 95% CI, 2.4-6.2) . The frequency of variceal bleeding also increases in direct proportion to the number and size of the spiders.

References

1.  Udell, JA, Wang CS (2012) Tinmouth J, et al. Does this patient with liver disease have cirrhosis. JAMA 307:832-842.

2. Foutch PG, Sullivan JA, Gaines JA, Sanowski RA (1988) Cutaneous vascular spiders in cirrhotic patients: correlation with hemorrhage from esophageal varices. Am J Gastroenterol  83:723-726.

 

Corresponding author

HU Rehman
Department of Medicine
Regina General Hospital
Canada