[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Blood vessels](https://durgical.com/en/general-pathology/areas/vessels/) › Vascular ectasias

# Vascular ectasias

- Lesion

Ectasias are dilated pre-existing small vessels, not tumours: red-purple patches, spider-shaped spots or tiny red dots that bleed.

Updated Nov 12, 2026

## Key points

- Nevus flammeus (salmon patch, ‘stork bite’) on the neck or forehead usually fades; port-wine stains persist.
- Port-wine stain in the trigeminal territory with leptomeningeal angioma and seizures: Sturge–Weber syndrome (GNAQ mosaicism).
- Spider angiomas: face, neck, upper chest; pregnancy and cirrhosis (hyperestrogenism).
- Hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu): ENG, ACVRL1 (ALK1) or SMAD4; recurrent nosebleeds and GI bleeding, iron deficiency.
- Lung arteriovenous malformations in HHT allow paradoxical emboli and brain abscesses.

## What it is

Vascular ectasias are local dilations of existing vessels. The nevus flammeus is a congenital flat pink-purple patch; the port-wine stain is a type that persists, grows with the child and may be part of Sturge–Weber syndrome. Spider telangiectasias are radiating arterioles around a central core that blanch with pressure; they appear with high estrogen (pregnancy, cirrhosis). Hereditary haemorrhagic telangiectasia is an autosomal dominant disorder of TGF-β family signalling with telangiectasias of skin and mucosa and arteriovenous malformations in lung, liver and brain.

## Structure

- Nevus flammeus: dilated capillaries in the dermis.
- Spider telangiectasia: a central pulsating arteriole with radiating thin-walled vessels.
- HHT: dilated thin-walled capillaries and venules connected directly to arterioles in mucosa and skin.

## Three ectasias to recognise

| Lesion | Appearance | Associations |
| --- | --- | --- |
| Nevus flammeus and port-wine stain | Flat pink to purple patch present at birth | Sturge–Weber syndrome when on the face with brain involvement |
| Spider telangiectasia | Red central point with radiating legs that blanch | Pregnancy, cirrhosis, high estrogen |
| [Hereditary haemorrhagic telangiectasia](https://durgical.com/en/conditions/hereditary-haemorrhagic-telangiectasia/) | Small red spots on lips, tongue, nose, fingertips | Nosebleeds, GI bleeding, AV malformations of lung, liver, brain |

## Clinical notes

- Chronic blood loss in HHT is a frequent cause of iron-deficiency anaemia; screening for lung and brain AV malformations is advised.

## Memory aid

Born with a stain, a spider from too much estrogen, and red dots that bleed in families: three ectasias, none of them a tumour.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the inheritance pattern of hereditary haemorrhagic telangiectasia?

Autosomal dominant (genes such as ENG, ACVRL1 and SMAD4 in the TGF-β/BMP pathway).

## Why do spider angiomas appear in cirrhosis?

The failing liver clears estrogen poorly; hyperestrogenism dilates small arterioles of the skin.

## Which syndrome combines a facial port-wine stain, leptomeningeal angiomas and seizures?

Sturge–Weber syndrome.

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## Elsewhere in DurgiPedia

- [Blood vessels: artery, vein and capillary layers](https://durgical.com/en/histology/blood-vessels-artery-vein-and-capillary-layers/)

## Connections

## Related 4

- [Benign vascular tumours](https://durgical.com/en/general-pathology/benign-vascular-tumours/)
- [Vascular anomalies: berry aneurysm, AV fistula, fibromuscular dysplasia](https://durgical.com/en/general-pathology/vascular-anomalies-berry-aneurysm-av-fistula-fibromuscular-dysplasia/)
- [Vascular bleeding disorders](https://durgical.com/en/general-pathology/vascular-bleeding-disorders/)
- [Angiodysplasia](https://durgical.com/en/general-pathology/angiodysplasia/)

## Related conditions 2

- [Hereditary haemorrhagic telangiectasia (Osler–Weber–Rendu)](https://durgical.com/en/conditions/hereditary-haemorrhagic-telangiectasia/)
- [Cirrhosis](https://durgical.com/en/conditions/cirrhosis/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Hereditary hemorrhagic telangiectasia: MedlinePlus Genetics](https://medlineplus.gov/genetics/condition/hereditary-hemorrhagic-telangiectasia/) (MedlinePlus, US National Library of Medicine, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/vascular-ectasias/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/vascular-ectasias/