If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password
If the address matches a valid account an email will be sent to __email__ with instructions for resetting your password
Department of Radiology, West Virginia University, Morgantown, WV 26506, United StatesDepartment of Neuroradiology, School of Medicine, West Virginia University, Morgantown, WV 26506, United States
A 23-year-old female with past medical history of generalized anxiety disorder and migraine presents to the clinic with unintentional weight loss of approximately 20 lbs and chronic episodic abdominal pain associated with nausea and vomiting for 6-8 weeks. Physical examination and initial blood workup were unremarkable.
Dynamic CT angiogram of the abdomen and pelvis was performed, with image acquisition during inspiratory phase (Fig. 1A), and end-expiratory phase (Fig. 1B and 1C). 3D reconstruction image is depicted in Fig. 1D.
Fig. 1Dynamic CT angiogram of the abdomen and pelvis with images acquired during inspiratory (Fig. 1A), and end-expiratory phase (Fig. 1B and 1C). 3D reconstruction image during end-expiratory phase is illustrated in Fig. 1D. There is dynamic compression of proximal celiac artery (arrow) due to external compression from median arcuate ligament, most accentuated during end-expiratory phase, compatible with Median Arcuate Ligament Syndrome.
What is the most likely etiology of patients’ symptoms?
Diagnosis
Median Arcuate Ligament Syndrome
Discussion
Dynamic CT angiogram of the abdomen and pelvis with image acquisition during inspiratory phase (Fig. 1A), and end-expiratory phase (Fig. 1B and 1C) that demonstrates dynamic compression of proximal celiac artery (arrow) due to external compression from median arcuate ligament. 3D reconstruction image during end-expiratory phase is illustrated in Fig. 1D. Patient was diagnosed with median arcuate ligament syndrome [
Median arcuate ligament syndrome, also known as Dumbar or Harjola-Marable syndrome, is a rare condition with reported incidence of 2 per 100,000 population [
]. It presents with chronic positional abdominal pain from compression of celiac trunk. The degree of compression varies with respiration, most accentuated during end-expiration when the two structures move close together. The etiology of pain is hypothesized to be ischemic from impaired blood flow secondary to compression [
CT angiography can play a role in the diagnosis of this condition by demonstrating the characteristic focal narrowing of the celiac artery in patients presenting with the appropriate clinical symptoms [
]. Since, many patients have compression of celiac axis from low insertion of median arcuate ligament without any clinical symptoms, and are incidentally diagnosed on imaging [
00075-3&id=gr1.jpg){kind=link}