Median arcuate ligament syndrome and acute appendicitis

Case contributed by Dr Sami Elhinnawi


Fever, right iliac fossa pain and tenderness. History of chronic epigastric pain.

Patient Data

Age: 35 years
Gender: Male

2D ultrasound images show kinking of the celiac trunk origin. 

Color doppler examination shows aliasing at the proximal part of the celiac 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 celiac artery compression.

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 celiac trunk origin showing a characteristic hooked appearance due to indentation on its superior surface.

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

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

Case Discussion

A case of median arcuate ligament syndrome discovered incidentally 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
Published: 6th Sep 2017
Last edited: 29th Dec 2019
System: Vascular
Inclusion in quiz mode: Included
Institution: Misr International Hospital

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