27 Y/O woman with abdominal pain with normal upper endoscopy



Doctor's Information

Name : Amir Reza
Family :Radmard
Affiliation : Radiology Departement of Shariati Hospital
Academic Degree: Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Reza Hanifehpour


Case Section


Patient's Information

Gender : Female
Age : 27


Clinical Summary

27 Y/O woman with abdominal pain with normal upper endoscopy and evaluation for gallbladder disease and gastroesophageal reflux disease (GERD).



Imaging Findings

There is a considerable luminal narrowing in proximal portion of celiac artery without obvious intraluminal filling defect, which could be due to an extrinsic pressure effect compatible with celiac artery compression syndrome caused by hypertrophied arcuate ligament. No obvious adjacent LAP or mass is found. There is also splenomegaly .


Differential Diagnosis



Final Diagnosis

celiac artery compression syndrome


Discussion (Related Text)

Median arcuate ligament syndrome(MALS) or celiac artery compression syndrome results from compression of the celiac artery and possibly the celiac ganglia by the median arcuate ligament. The median arcuate ligament ,a fibrous arch formed by the left and right diaphragmatic crura, is normally several millimeters to centimeters superior to the origin of the celiac artery. In MALS, the ligament is anterior to the celiac artery, resulting in compression of the vessel. It is estimated that in 10-24% of normal, asymptomatic individuals the median arcuate ligament crosses in anterior to the celiac artery, causing some degree of compression. Approximately 1% of these individuals exhibit severe compression associated with symptoms of MALS. The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women. Clinical features include is abdominal pain after eating particularly in the epigastrium, anorexia and weight loss, and an abdominal bruit. Diagnostic imaging for MALS is divided into screening and confirmatory tests. A reasonable screening test for patients with suspected MALS is duplex ultrasonography to measure blood flow through the celiac artery. Peak systolic velocities greater than 200 cm/s are suggestive of celiac artery stenosis associated with MALS. CT angiographic findings in MALS are Focal narrowing of proximal celiac artery with poststenotic dilatation, Indentation on superior aspect of celiac artery, Hook-shaped contour of celiac artery. These imaging features are exaggerated on expiration, even in normal asymptomatic individuals without the syndrome. Proximal celiac artery stenosis with poststenotic dilatation can be seen in other conditions affecting the celiac artery. The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. This hooked contour is not entirely specific for MALS however, given that 10-24% of normal asymptomatic individuals have this anatomy.





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