Median arcuate ligament syndrome

Case contributed by Dr Sami Elhinnawi

Presentation

Chronic epigastric pain, came to the ER presenting with fever and right iliac fossa pain and tenderness.

Patient Data

Age: 35
Gender: Male
Ultrasound

2D ultrasound images shows kinking of the coeliac trunk origin, colour doppler examination shows aliasing at the proximal part of the coeliac trunk more prominent on the supine position, the peak expiratory velocity reaches 450 cm/ sec. peak inspiratory velocity reaches 200 cm/sec and the erect velocity measures 205 cm/sec. ultrasound picture suggests external coeliac artery compression.

Ultrasound

Scanning the right iliac fossa, the appendix is seen inflamed showing increased mural thickness with no evidence of obstruction. there is surrounding mild free fluid with no evidence of appendicular phlegmon or abscess formation.

CT angiography shows focal narrowing of the coeliac trunk origin showing a characteristic hooked appearance due to indentation on its superior surface.

3D reconstruction images show the characteristic appearance of coeliac trunk compression.

The appendix shows increased diameter with surrounding mild fat stranding consistent with acute appendicitis.

Case Discussion

A case of coeliac trunk compression syndrome discovered accidentally in an ER patient complaining of abdominal pain.

Patients are often asymptomatic, however, if symptomatic surgical decompression is performed by dividing the median arcuate ligament.

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Case information

rID: 55455
Case created: 6th Sep 2017
Last edited: 11th Sep 2017
System: Vascular
Inclusion in quiz mode: Included
Institution: Misr International Hospital

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