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Median arcuate ligament syndrome is a condition in which the median arcuate ligament crosses the aorta in a lower than normal position and compresses the celiac artery during respiration. The effects of compression are most notable during suspended expiration and when the patient is supine. Patients with median arcuate ligament syndrome present with postprandial abdominal pain, nausea, vomiting, weight loss, and abdominal bruit. The compression leads to a narrowing of the artery, which could cause bowel ischemia, although this theory is controversial. Alternately, the median arcuate ligament could compress the celiac plexus, causing an inflammatory reaction from the nerves and producing a pain pattern that is similar to ischemia.Computed tomography and Doppler ultrasonography have high sensitivity and specificity to detect and monitor median arcuate ligament syndrome. Neither imaging modality shows superiority to the other, and the selection of either to image median arcuate ligament syndrome should be based on the patient's needs.Treatment for median arcuate ligament syndrome ranges from stenting to open celiac artery decompression with revascularization and results in only a fair degree of long-term symptom relief. |
