This patient had a chronic history of vague upper abdominal symptoms.
Initial CT had the unexpected finding of coeliac artery stenosis. This is a smooth stenosis with the appearance of external compression. CT findings were compatible with median arcuate ligament syndrome, where the median arcuate ligament compresses the proximal coeliac artery (also known as Dunbar syndrome). This characteristic appearance of the coeliac artery compression may however be seen in normal subjects, especially when imaged during expiration. CT however had some secondary signs supporting the diagnosis including post stenotic dilatation and suspected pancreatico-duodenal collaterals.
The patient then underwent conventional angiography. Selective coeliac injections were done in both inspiration and expiration. During inspiration the appearance was similar to the CT with smooth, fairly tight stenosis and post stenotic dilatation. During expiration there was however no flow through the stenosis which was completely compressed. This together with the retrograde filling of the coeliac branches, when injecting the superior mesenteric artery confirmed the significance of the compression in the patient. Angiography findings further supported the diagnosis of Median Arcuate Ligament Syndrome.
Patient underwent surgery 2 days later to decompress the coeliac artery.