Doppler ultrasound diagnosis of an unusual variant of median arcuate ligament syndrome: concomitant involvement of celiac and superior mesenteric arteries. A case report

Abstract

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome is a rare condition characterized by chronic mesenteric ischemia, secondary to the compression of the celiac artery by the median arcuate ligament. Occasionally, in addition to the celiac artery, the superior mesenteric artery may be partially compressed by the median arcuate ligament. We report a case with complaints of chronic abdominal pain from compression of both the celiac artery and the superior mesenteric artery due to MALS, which was primarily detected by Doppler ultrasound. The diagnosis was confirmed with CT-angiography.

Multidetector Computed Tomographic Angiography for Optimal Cartography of the Visceral Abdominal Arterial Network: An Extensive Pictorial Review with Emphasis on Common and Uncommon Collateral Pathways, Complications and some Specific Syndromes

“…As confirmed by several studies the CTCS of MALS is better appreciated during expiration (Figure 2 ) especially during dynamic duplex and color flow Doppler sonography that are considered by various authors as excellent diagnostic modalities to diagnose significant MALS and to distinguish it from a real atheromatous CTK stenosis in which respiratory variation are absent [ 7 9 11 12 14 ].…”

“…During MDCTA the MALS exhibits a characteristic hooked appearance of the focal narrowing of the CTK and the deformation increases during expiration (Figures 1 and 2 ). This aspect is clearly distinctive from other causes of stenosis such atherosclerosis [ 9 ]. Poststenotic dilatation of the compressed CTK is also common as well as the development of collaterals which essentially concern serpiginous hypertrophy of the Gastroduodenal Artery (GDA) and of the cephalic pancreatic arcades (CPAs) (Figures 1 and 3 ).…”

“…The Dunbar syndrome induced by the celiac trunk compression syndrome (CTCS) also called the median arcuate ligament syndrome (MALS) is a potential clinical entity characterized by a triad comprising epigastric pain, weight loss and postprandial pain with nausea and vomiting [ 5 6 7 8 9 10 ]. These symptoms are believed to be secondary to intermittent ischemia especially during the expiration phase [ 8 ].…”

“…These symptoms are believed to be secondary to intermittent ischemia especially during the expiration phase [ 8 ]. These symptoms are attenuated when the patient is in an erect position and during inspiration [ 6 9 ]. Indeed, in these positions the CTK descends in the abdominal cavity and becomes more vertical resulting in a relief or attenuation of the compression [ 7 9 11 12 ].…”

“…The physiopathology of MALS is also controversial: are the symptoms really caused by ischemia of the gut itself or by neurogenic compression or ischemia of the celiac ganglion [ 9 ]?…”