DOI: 10.1148/rg.255055001
Median Arcuate Ligament Syndrome: Evaluation with CT Angiography1
Karen M. Horton, MD,
Mark A. Talamini, MD and
Elliot K. Fishman, MD
1 From the Russell H. Morgan Department of Radiology and Radiological Sciences (K.M.H., E.K.F.) and Department of Surgery (M.A.T.), Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 3253, Baltimore, MD 21287. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received January 7, 2005; revision requested January 26 and received February 22; accepted February 25. All authors have no financial relationships to disclose.
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Figure 1. Drawing from the sagittal perspective demonstrates the typical anatomy of the median arcuate ligament as it crosses anterior to the aorta and superior to the origin of the celiac axis.
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Figure 2. Another sagittal view shows a normal variant anatomy in which the median arcuate ligament crosses the proximal portion of the celiac axis, causing an indentation.
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Figure 3. Diagrams show the orientation of the celiac axis during inspiration (3) and expiration (4).
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Figure 4. Diagrams show the orientation of the celiac axis during inspiration (3) and expiration (4).
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Figure 5a. (a) Sagittal 3D volume-rendered image of a normal aorta demonstrates the normal appearance of the celiac axis and superior mesenteric artery. (b) Coronal oblique 3D volume-rendered image shows the normal anatomy of the celiac axis and superior mesenteric artery.
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Figure 5b. (a) Sagittal 3D volume-rendered image of a normal aorta demonstrates the normal appearance of the celiac axis and superior mesenteric artery. (b) Coronal oblique 3D volume-rendered image shows the normal anatomy of the celiac axis and superior mesenteric artery.
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Figure 6a. (a) Sagittal 3D volume-rendered image shows normal anatomy of the celiac axis and superior mesenteric artery. In this case, there is a slight impression (arrow) in the proximal celiac axis, which may be related to a nonobstructing median arcuate ligament. (b) As evident from this axial oblique 3D volume-rendered image of the same patient, the median arcuate ligament and the indentation it causes on the proximal celiac axis can be difficult to detect in the axial plane.
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Figure 6b. (a) Sagittal 3D volume-rendered image shows normal anatomy of the celiac axis and superior mesenteric artery. In this case, there is a slight impression (arrow) in the proximal celiac axis, which may be related to a nonobstructing median arcuate ligament. (b) As evident from this axial oblique 3D volume-rendered image of the same patient, the median arcuate ligament and the indentation it causes on the proximal celiac axis can be difficult to detect in the axial plane.
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Figure 7a. (a) Sagittal 3D image of a patient with epigastric pain demonstrates acute angulation and narrowing of the proximal celiac axis. There is minimal poststenotic dilatation, which creates a "hooked" appearance (arrow) that is characteristic of median arcuate ligament syndrome. (b) Coronal oblique CT angiogram of the same patient reveals a prominent collateral vessel and dilatation of the gastroduodenal artery (arrowhead) that is supplying the common hepatic artery (short arrow) off the superior mesenteric artery (long arrow). This configuration is a common collateral pathway seen in patients with celiac axis stenosis. The patient underwent surgical decompression and experienced relief of symptoms.
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Figure 7b. (a) Sagittal 3D image of a patient with epigastric pain demonstrates acute angulation and narrowing of the proximal celiac axis. There is minimal poststenotic dilatation, which creates a "hooked" appearance (arrow) that is characteristic of median arcuate ligament syndrome. (b) Coronal oblique CT angiogram of the same patient reveals a prominent collateral vessel and dilatation of the gastroduodenal artery (arrowhead) that is supplying the common hepatic artery (short arrow) off the superior mesenteric artery (long arrow). This configuration is a common collateral pathway seen in patients with celiac axis stenosis. The patient underwent surgical decompression and experienced relief of symptoms.
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Figure 8a. (a) Sagittal volume-rendered CT angiogram of a patient with abdominal pain demonstrates characteristic kinking of the proximal celiac axis, creating a hooked appearance (arrow). (b) Coronal maximum intensity projection CT angiogram shows the prominent gastroduodenal artery that feeds the common hepatic artery off the superior mesenteric artery.
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Figure 8b. (a) Sagittal volume-rendered CT angiogram of a patient with abdominal pain demonstrates characteristic kinking of the proximal celiac axis, creating a hooked appearance (arrow). (b) Coronal maximum intensity projection CT angiogram shows the prominent gastroduodenal artery that feeds the common hepatic artery off the superior mesenteric artery.
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Figure 9. Sagittal 3D volume-rendered image of a patient with abdominal pain demonstrates a focal narrowing of the proximal celiac axis caused by atherosclerotic disease. This appearance is distinct from the hooked appearance seen in median arcuate ligament syndrome.
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Figure 10. Sagittal maximum intensity projection image of a patient with recurrent abdominal pain reveals focal calcified plaque that causes narrowing of the proximal celiac axis. There is minimal poststenotic dilatation.
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Copyright © 2005 by the Radiological Society of North America.
