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

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.

Median Arcuate Ligament Syndrome Revealed by Splenic Infarcts

“…MALS occurs in approximately 2% and typically affects young patients (20–40 years of age). It is more common in thin women [ 1 ]. Clinical symptoms include postprandial epigastric pain, anorexia, and weight loss.…”

“…Clinical symptoms include postprandial epigastric pain, anorexia, and weight loss. Physical examination may reveal an abdominal bruit in the midepigastric region [ 1 ].…”

“…Doppler ultrasound may evaluate the severity of artery stenosis in both phases of respiration. A systolic velocity in the celiac artery more than 250 cm/s on average is highly suggestive of MALS [ 1 ].…”

“…Significant cases of MALS require surgical release of the celiac artery from compression with simultaneous removal of the nerves that are being compressed as well and endovascular stenting of the celiac artery [ 1 ].…”

Median arcuate ligament syndrome (Dunbar syndrome): A diagnosis not to be underestimated

“…Clinically, MALS is classically characterized by epigastric pain, vomiting, and weight loss [1] . The diagnosis of MALS is one of exclusion, which is made after ruling out all other causes of chronic abdominal pain, and is confirmed by invasive and/or noninvasive vascular radiological examinations and/or noninvasive vascular radiology [2] . In terms of treatment, the majority of authors accept the value of surgical treatment for symptomatic patients.…”