Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2021 Sep 16;16(11):3614-3617.
doi: 10.1016/j.radcr.2021.06.093. eCollection 2021 Nov.

Median arcuate ligament syndrome diagnosis on Computed Tomography: what a radiologist needs to know

Pooja Narwani  1 , Navin Khanna  1 , Ishwariya Rajendran  1 , Hesham Kaawan  2 , Rafid Al-Sam  1
Affiliations
Case Reports

Median arcuate ligament syndrome diagnosis on Computed Tomography: what a radiologist needs to know

Pooja Narwani et al. Radiol Case Rep. .

Abstract

Median arcuate ligament syndrome or celiac artery compression syndrome is one of the abdominal vascular compression syndromes due to compression of proximal celiac artery by the median arcuate ligament. The median arcuate ligament unites diaphragmatic crura on either side at the level of aortic hiatus. The ligament has a low insertion causing compression of the celiac artery resulting in clinical symptoms of postprandial pain and weight loss. It is a rare syndrome, detected incidentally on routine Computed Tomography abdomen and pelvis studies. We present a rare case of a 35-year-old female who presented with abdominal pain. She was evaluated by Computed Tomography scan of the abdomen and pelvis. Ultrasound Doppler of mesenteric vasculature helped detect celiac artery stenosis. A referral to the vascular surgery department was made; however, the patient was managed conservatively.

Keywords: Celiac artery compression; Celiac artery stenosis; Computed Tomography (CT); Diagnostic Radiology; Median arcuate ligament syndrome (MALS); Ultrasound Doppler; Vascular compression syndrome.

PubMed Disclaimer

Figures

Fig 1
Fig. 1
(A): Contrast-enhanced CT of the abdomen, parasagittal reconstruction, shows kinking of the proximal celiac artery, resulting in characteristic hooked appearance with post stenotic dilatation. Note the absence of atherosclerosis. (B): Contrast-enhanced CT of the abdomen, parasagittal reconstruction, shows post stenotic dilatation of the celiac artery.
Fig 2
Fig. 2
(A): Contrast-enhanced CT axial image of the abdomen shows proximal stenosis of the celiac artery. (B): Contrast-enhanced CT axial image of the abdomen shows proximal stenosis accompanied by post stenotic dilatation, although it is better appreciated on Sagittal CT image.
Fig 3
Fig. 3
(A): Ultrasound Abdomen image shows the origin of celiac artery from the aorta. (B): Ultrasound Color Doppler with spectral analysis of coeliac artery shows elevated PSV >250 cm/s during inspiration. Note the turbulent flow in the post stenotic segment.
See this image and copyright information in PMC

References

    1. Harjola PT. A rare obstruction of the coeliac artery. Ann Chir Gynaecol Fenn. 1963;52:547–550. Report of a case. - PubMed
    1. Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 1965;95(3):731–744. doi: 10.2214/ajr.95.3.73. - DOI - PubMed

    2. PMID: 5844938.

    1. Duran M, Simon F, Ertas N, Schelzig H, Floros N. Open vascular treatment of median arcuate ligament syndrome. BMC Surg. 2017;17:95. - PMC - PubMed
    1. Linder HH, Kemprud E. A clinicoanatomic study of the arcuate ligament of the diaphragm. Arch Surg. 1971;103:600–605. - PubMed
    1. Weber JM, Boules M, Fong K, Abraham B, Bena J, El-Hayek K. Median arcuate ligament syndrome is not a vascular disease. Ann Vasc Surg. 2016;30:22. 7.20. - PubMed

Publication types

LinkOut - more resources