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 ischemia as the cause of his symptoms.
Patient Data
Compression at the origin of the celiac 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.
Annotations illustrating the compression of the celiac 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.
Case courtesy: Dr Fabio Denicolò