Median arcuate ligament syndrome (Dunbar syndrome)

Case contributed by Dr Domenico Nicoletti

Presentation

60 year old man with a medical history of postprandial cramping pain, weight loss and nausea worsening hospitalized at the Department of Internal Medicine. CT angiography was performed to exclude ischaemia as the cause of his symptoms.

Patient Data

Age: 60
Gender: Male

Compression at the origin of the coeliac trunk where there is a small calcification. Three renal artery are visible on the left, one median and two polar, of which the lower polar originates from caudal to the origin of the inferior mesenteric artery. Moderate peritoneal fluid.

Modality: Annotated image

Annotations illustrating the compression of the coeliac trunk.

Case Discussion

Median arcuate ligament syndrome was first described in 1963 by Harjola. Diagnosis is based on a combination of clinical and radiological features. It usually affects young patients (20-40 years) and is more common in thin women. The symptoms are due to extrinsic compression of the celiac axis by the median arcuate ligament resulting in impaired blood flow. During impairment, a sudden decrease in vessel diameter is noted along the proximal celiac axis, usually within 5 mm of its origin from the abdominal aorta. The symptoms of nausea and vomiting are due to secondary gastroparesis.

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Case Information

rID: 45205
Case created: 17th May 2016
Last edited: 20th May 2016
Inclusion in quiz mode: Excluded

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