An Unusual Presentation of Median Arcuate Ligament Syndrome

Abstract

Median arcuate ligament syndrome (MALS) is a rare benign condition typically affecting young females. It usually presents with abdominal symptoms of pain, nausea, and unintentional weight loss. They are usually diagnosed incidentally on CT of the abdomen done for abdominal pain. Here we present a rare case of MALS which presented with an anginal type of chest pain without any abdominal symptoms leading to an extensive workup and incidental diagnosis.

Another Sherlock Holmes Mystery: Abdominal Pain Explained by Median Arcuate Ligament Syndrome

“…In 1917, Lipshutz was the first to describe what we know as MALS today. 7 , 8 The clinical presentation typically consists of nausea, vomiting, postprandial pain, and weight loss symptoms, which can also be present across a spectrum of more common etiologies of abdominal pain. Epigastric pain has been the most reported symptom in 100% of patients, weight loss in 48% to 67% of patients, and nausea and diarrhea in approximately 8% to 10% of patients.…”

“…Epigastric pain has been the most reported symptom in 100% of patients, weight loss in 48% to 67% of patients, and nausea and diarrhea in approximately 8% to 10% of patients. 8 - 10 …”

Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome

“…Symptoms have been found to occur more frequently in patients with more pronounced celiac artery compression on imaging and those with prior abdominal surgery [ 10 ]. On physical examination, patients may have abdominal bruits (85%), but up to 30% of patients without this condition may also have this finding [ 11 ]. As its symptoms closely mimic those of other abdominal pathologies, MALS is often considered a diagnosis of exclusion.…”

“…One study suggested that persistent symptoms should be investigated for a co-morbidity or unresolved stenosis of the artery [ 6 ]. An initial surgery that fails to resolve the patient's symptoms may suggest the patient is a candidate for further interventions such as endovascular techniques or vascular bypass [ 11 ]. Endovascular stent placement by interventional radiology or vascular surgery has become the preferred treatment in cases of residual stenosis or aneurysm development of the celiac artery following primary surgical decompression.…”

Hiatal Hernia: A Possible Trigger for Atrial Fibrillation

“…They have been linked together by the term gastrocardiac syndrome. This term was first coined by Ludwig Roemheld wherein he described how certain gastrointestinal pathologies can present with cardiovascular symptoms [9]. Hiatal hernia tends to be one of these postulated gastrointestinal pathologies and is suspected to be a trigger for cardiac arrhythmias [6].…”