An unusual case of left renal artery compression: a rare type of median arcuate ligament syndrome

Abstract

Compression from median arcuate ligament was observed during multidetector 64-row computed tomography in a Caucasian 30-year-old female. The patient was referred for examination to exclude anatomical pathologies causing hypertension. The examination demonstrated that left renal artery, which had its origin in the chest (at the level of upper one-third of Th12), was compressed as it passed by median arcuate ligament of the diaphragm. In addition, aortic compression and kinked shape was also revealed.

Renovascular hypertension secondary to renal artery compression by diaphragmatic crura

“…Multiple reports, including ours, also describe hypertrophic and fibrotic bands of crura. 14 Arazi nska et al 16 diagnosed secondary renovascular hypertension due to MAL compression of an LRA at T12 with hypertrophic muscle also kinking the distal descending thoracic aorta. Extrinsic compression should therefore be considered in unusually high renal origins with adjacent prominent MAL in the setting of renovascular hypertension.…”

Renal artery entrapment — anatomical risk factors rating

“…Due to thoracic aorta kinking, origins of CT and LRA were 10 mm away from each other, but perpendicularly the distance came to 3 mm. The distance between origins of LRA and RRA equalled 62 mm [2]. With regard to literature review, the most common configuration originates from the lower margin of the L1 vertebra (25%) on the right side and from the upper margin of the L2 vertebra (24%) on the left side [14].…”

Retroperitoneal Hematoma: Rupture of Aneurysm in the Arc of Bühler Caused by Median Arcuate Ligament Syndrome

“…Computed tomography angiography (CTA), magnetic resonance angiography (MRA), Doppler ultrasound (US), and intravascular ultrasound (IVUS) are useful as diagnostic methods. 7,8 Regarding treatment, with advances in intervention radiology (IVR), non-invasive transcatheter procedures have been established as safe and effective therapeutic strategies. 9 Previous reports have raised the possibility that the development of new aneurysms is low after administration of only IVR as treatment for focal aneurysms without resection of the arcuate ligament.…”