IS Case 204: Median arcuate ligament syndrome

Keith Forrest Dockery, MD


Imaging Sciences URMC 2008
Publication Date: 2009-05-22

History

A 63-year-old male with hypertension undergoing renal ultrasound evaluation, found to have infra-renal aortic dissection, initially asymptomatic. Subsequently, with aphasia and sensory deficit which resolved. Sent for CT evaluation of aneurysm.

Findings

Ligamentous band across the origin of the celiac artery, resulting in a hooked appearance on sagittal reformatted images. Celiac artery was patent on contrast enhanced study.

Discussion

The median arcuate ligament typically courses superior to the celiac axis, however in 10-24% of people it crosses anteriorly at the proximal celiac artery. If the resulting compression of the celiac artery results in a clinically significant decrease in blood flow, then the diagnosis of median arcuate ligament syndrome is made. Another name for this syndrome is celiac artery compression syndrome. In this patient, the finding was incidentally made during evaluation for an abdominal aortic aneurysm and the patient was asymptomatic, i.e. no symptoms of mesenteric ischemia.

The primary modality for evaluation is three-dimensional reformatted thin-section multidetector computed tomography.

Of note, the celiac compression varies with respiration, increasing with expiration.

References

  1. Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005 Sep-Oct;25(5):1177-82. [PMID: 16160104]

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