Fibrous band that bridges diaphragmatic crura anteriorly around aorta, creating aortic hiatus centrally
Usually originates above celiac artery origin, just superior to level of L1 vertebral body
In 10-24% of all people, ligament is low lying, sitting anterior to celiac axis
May result in some degree of compression &/or angulation of vessel, degree of which can vary throughout respiratory cycle
MALS diagnosed when patient has abnormal morphology of median arcuate ligament and celiac artery combined with clinical symptoms, typically including abdominal pain, weight loss, nausea, and others
Clinical symptoms or imaging findings alone not sufficient for diagnosis as many imaging characteristics found in asymptomatic people
IMAGING
General Features
Ultrasonographic Findings
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Reporting Tips
Selected References
Kim EN et al: Median arcuate ligament syndrome-review of this rare disease. JAMA Surg. 151(5):471-7, 2016
Fong JK et al: Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol. 203(1):29-36, 2014
AbuRahma AF et al: Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 55(2):428-436.e6; discussion 435-6, 2012
Chou JW et al: Celiac artery compression syndrome: an experience in a single institution in taiwan. Gastroenterol Res Pract. 2012:935721, 2012
Gruber H et al: Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 14(1):5-9, 2012
Scholbach T: Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases. J Ultrasound Med. 25(3):299-305, 2006
Horton KM et al: Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 25(5):1177-82, 2005
Sproat IA et al: US case of the day. Median arcuate ligament syndrome (celiac artery compression syndrome). Radiographics. 13(6):1400-2, 1993
Cornell SH: Severe stenosis of the celiac artery. Analysis of patients with and without symptoms. Radiology. 99(2):311-6, 1971
Dunbar JD et al: Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 95(3):731-44, 1965
HARJOLA PT: A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn. 52:547-50, 1963
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Abbreviations
Median arcuate ligament syndrome (MALS)
Synonyms
Celiac arcuate ligament syndrome
Celiac axis syndrome
Celiac trunk compression syndrome
Dunbar syndrome
Definitions
Median arcuate ligament
Fibrous band that bridges diaphragmatic crura anteriorly around aorta, creating aortic hiatus centrally
Usually originates above celiac artery origin, just superior to level of L1 vertebral body
In 10-24% of all people, ligament is low lying, sitting anterior to celiac axis
May result in some degree of compression &/or angulation of vessel, degree of which can vary throughout respiratory cycle
MALS diagnosed when patient has abnormal morphology of median arcuate ligament and celiac artery combined with clinical symptoms, typically including abdominal pain, weight loss, nausea, and others
Clinical symptoms or imaging findings alone not sufficient for diagnosis as many imaging characteristics found in asymptomatic people
IMAGING
General Features
Ultrasonographic Findings
Radiographic Findings
CT Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Reporting Tips
Selected References
Kim EN et al: Median arcuate ligament syndrome-review of this rare disease. JAMA Surg. 151(5):471-7, 2016
Fong JK et al: Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol. 203(1):29-36, 2014
AbuRahma AF et al: Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 55(2):428-436.e6; discussion 435-6, 2012
Chou JW et al: Celiac artery compression syndrome: an experience in a single institution in taiwan. Gastroenterol Res Pract. 2012:935721, 2012
Gruber H et al: Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 14(1):5-9, 2012
Scholbach T: Celiac artery compression syndrome in children, adolescents, and young adults: clinical and color duplex sonographic features in a series of 59 cases. J Ultrasound Med. 25(3):299-305, 2006
Horton KM et al: Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 25(5):1177-82, 2005
Sproat IA et al: US case of the day. Median arcuate ligament syndrome (celiac artery compression syndrome). Radiographics. 13(6):1400-2, 1993
Cornell SH: Severe stenosis of the celiac artery. Analysis of patients with and without symptoms. Radiology. 99(2):311-6, 1971
Dunbar JD et al: Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 95(3):731-44, 1965
HARJOLA PT: A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn. 52:547-50, 1963
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