The relationship between spider naevi & de novo arteriovenous malformations in chronic liver disease.

We report a patient with decompensated alcoholic liver cirrhosis (Child-Turcotte-Pugh class C) who developed a left frontal cerebral AVM and a subcutaneous left temporal scalp spider naevus. Arteriovenous malformations (AVMs) are vascular abnormalities previously thought to be congenital in nature, although new research has revealed the potential for AVM formation through a two-hit hypothesis. We propose that the oestrogen-rich environment seen in chronic liver disease could act as the second hit to allow for an angiogenic state favouring AVM development.