Median arcuate ligament syndrome

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[edit] Discussion of Median arcuate ligament syndrome

  • Median arcuate ligament syndrome refers to clinically significant celiac axis compression by the median arcuate ligament.
  • The median arcuate ligament is a fibrous arch that unites the left and right diaphragmatic crura on either side of the aortic hiatus.
  • The ligament usually passes superior to the origin of the celiac axis.
  • In some people, the ligament inserts low and crosses the proximal portion of the celiac axis, causing compression and sometimes resulting in abdominal pain.

  • Surgical treatment is controversial: Because surgical ligation of the constricting median arcuate ligament has been performed with only variable success, many surgeons no longer believe the median arcuate ligament syndrome as a real clinical entity.

[edit] Imaging Findings for Median arcuate ligament syndrome

[edit] Conventional Angiography

  • When the median arcuate ligament passes anterior to the celiac axis, a characteristic superior indentation is noted along the proximal celiac axis, usually about 5 mm from its origin at the abdominal aorta.
    • Any compression caused by this indentation typically is less apparent during inspiration, when the celiac axis assumes a more caudal orientation as the lungs expand.
    • During expiration, compression of the celiac axis typically increases
    • Isolated compression of the celiac axis during expiration may not be clinically significant.

[edit] CT

  • CT is typically performed during inspiration.
  • Typically, the sagittal plane is optimal for visualizing the proximal portion of the celiac axis, and in many cases, 3D imaging also allows identification of the actual median arcuate ligament.
  • Characteristic focal narrowing in the proximal celiac axis. The focal narrowing has a characteristic hooked appearance, which can help distinguish this condition from atherosclerotic disease.

[edit] Images

Patient #1

[edit] See Also

[edit] External Links

[edit] References for Median arcuate ligament syndrome