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Median Arcuate Ligament Syndrome
Leann Kania, MD; Andrej Lyshchik, MD, PhD
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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

                                      1. Kim EN et al: Median arcuate ligament syndrome-review of this rare disease. JAMA Surg. 151(5):471-7, 2016
                                      2. Fong JK et al: Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol. 203(1):29-36, 2014
                                      3. AbuRahma AF et al: Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 55(2):428-436.e6; discussion 435-6, 2012
                                      4. Chou JW et al: Celiac artery compression syndrome: an experience in a single institution in taiwan. Gastroenterol Res Pract. 2012:935721, 2012
                                      5. Gruber H et al: Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 14(1):5-9, 2012
                                      6. 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
                                      7. Horton KM et al: Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 25(5):1177-82, 2005
                                      8. Sproat IA et al: US case of the day. Median arcuate ligament syndrome (celiac artery compression syndrome). Radiographics. 13(6):1400-2, 1993
                                      9. Cornell SH: Severe stenosis of the celiac artery. Analysis of patients with and without symptoms. Radiology. 99(2):311-6, 1971
                                      10. Dunbar JD et al: Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 95(3):731-44, 1965
                                      11. HARJOLA PT: A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn. 52:547-50, 1963
                                      Related Anatomy
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                                      Related Differential Diagnoses
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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

                                                                          1. Kim EN et al: Median arcuate ligament syndrome-review of this rare disease. JAMA Surg. 151(5):471-7, 2016
                                                                          2. Fong JK et al: Imaging findings and clinical features of abdominal vascular compression syndromes. AJR Am J Roentgenol. 203(1):29-36, 2014
                                                                          3. AbuRahma AF et al: Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 55(2):428-436.e6; discussion 435-6, 2012
                                                                          4. Chou JW et al: Celiac artery compression syndrome: an experience in a single institution in taiwan. Gastroenterol Res Pract. 2012:935721, 2012
                                                                          5. Gruber H et al: Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 14(1):5-9, 2012
                                                                          6. 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
                                                                          7. Horton KM et al: Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 25(5):1177-82, 2005
                                                                          8. Sproat IA et al: US case of the day. Median arcuate ligament syndrome (celiac artery compression syndrome). Radiographics. 13(6):1400-2, 1993
                                                                          9. Cornell SH: Severe stenosis of the celiac artery. Analysis of patients with and without symptoms. Radiology. 99(2):311-6, 1971
                                                                          10. Dunbar JD et al: Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 95(3):731-44, 1965
                                                                          11. HARJOLA PT: A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn. 52:547-50, 1963