Freitag, 16. Januar 2009


A 55-year-old man with end-stage liver disease associated with alcohol abuse was evaluated for liver transplantation. He had a history of refractory ascites and hepatic encephalopathy. On physical examination, we noted muscle atrophy, jaundice, ascites, and numerous spider angiomas (Panel A). Eight months later, the patient underwent successful liver transplantation, when he had a score of 21 on the Model for End-Stage Liver Disease (MELD) scale (ranging from 6 to 40, with higher scores indicating greater severity of disease). Six months after transplantation, he was clinically well without evidence of organ dysfunction or infection, and most of the spider angiomas had disappeared (Panel B).
Spider angiomas can be seen in healthy children and pregnant women. In such cases, angiomas are few in number and resolve with time or a normalization of estrogen levels. Numerous spider angiomas are more common in patients with chronic liver disease and consist of a central arteriole from which numerous small venules radiate, resembling a spider's legs. Possible mechanisms of formation include arteriolar vasodilatation, neovascularization from angiogenic factors such as vascular endothelial growth factor, direct effects of alcohol, and estrogen excess due to inadequate hepatic metabolism.

NEJM Volume 360:280 January 15, 2009 Number 3

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