Median arcuate ligament syndrome

Case contributed by Daniel Stanley Peter

Presentation

25 year old boy presented with chronic abdominal pain for 15 years (post prandial abdominal pain)

Modality: Ultrasound
  • Evidence of narrowing of celiac artery juxtaostially with fish hook configuration
  • Doppler in supine shows aliasing with increased flow velocity noted across the stenotic part of celiac artery
  • Doppler study confirms phasic variation of narrowing of celiac artery
Modality: CT
  • acute angulation and indendation on the superior aspect of proximal celiac axis
  • focal narrowing has a characteristic hooked appearance
  • poststenotic dilatation

Case Discussion

The median arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament usually passes superior to the origin of the celiac axis in MALS, compression of  the celiac axis, compromising blood flow and causing symptoms

With inspiration, the celiac artery descends in the abdominal cavity, resulting in a more vertical orientation of the celiac artery, which often relieves the compression.

With the patient in the erect position, the celiac artery descends farther in the abdominal cavity, resulting in an even more vertical orientation of the celiac artery and relief of compression by the ligament.

Ultrasound findings

  • Evidence of narrowing of celiac artery juxtaostially with fish hook configuration
  • Doppler in supine shows aliasing with increased flow velocity noted across the stenotic part of celiac artery
  • Doppler study confirms phasic variation of narrowing of celiac artery
  • On standing doppler study of celiac artery becomes normal

Ct angiography

  • acute angulation and indendation on the superior aspect of proximal celiac axis
  • focal narrowing has a characteristic hooked appearance
  • poststenotic dilatation
  • Coronal MIP CT angiogram shows the prominent gastroduodenal artery that feeds the common hepatic artery off the superior mesenteric artery
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Case Information

rID: 13095
Case created: 28th Feb 2011
Last edited: 24th Nov 2015
System: Vascular
Inclusion in quiz mode: Included

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