Median arcuate ligament syndrome
History of recurrent abdominal pain, mainly periumbilical related to meals. Currently presenting with persistent abdominal pain since one day. Referred as ? appendicitis.
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The celiac trunk showed U-shaped stenotic configuration with post-stenotic dilatation as well as mildly dilated hepatic and splenic branches. Normal wall and enhancing features of bowel loops with no evidence of ischemic changes. The appendix is normal.
In median arcuate ligament syndrome; the celiac trunk demonstrates a focal stenosis with characteristic hooked appearance due to the indentation on its superior surface. This appearance may be seen in normal people if imaging is acquired in expiration. So, the clinical history is mandatory to suggest such diagnosis. It usually presents in young age between 20 and 40 years. The young age of the patient and the characteristic hooked appearance distinguishes this syndrome from the main differential diagnosis of atherosclerotic disease.