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Median Arcuate Ligament Syndrome: Evaluation with CT Angiography¹

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. Address correspondence to K.M.H. (e-mail: kmhorton{at}jhmi.edu).

The median arcuate ligament is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. The ligament usually passes superior to the origin of the celiac axis. However, in some people, the ligament inserts low and thus crosses the proximal portion of the celiac axis, causing compression and sometimes resulting in abdominal pain. The diagnosis of clinically significant celiac axis compression, referred to as median arcuate ligament syndrome, is traditionally made with conventional angiography; however, the condition can now be diagnosed with three-dimensional computed tomographic (CT) angiography. In patients with median arcuate ligament syndrome, CT angiograms demonstrate a characteristic focal narrowing in the proximal celiac axis. The focal narrowing has a characteristic hooked appearance, which can help distinguish this condition from other causes of celiac artery narrowing, such as atherosclerotic disease. Once the disorder has been diagnosed, surgery can be performed to relieve the compression. In some patients, the ligamentous constriction of the celiac axis causes vascular damage, which may require vascular reconstruction. CT angiography can play a role in the diagnosis of median arcuate ligament syndrome by demonstrating the characteristic focal narrowing of the celiac artery in patients presenting with the appropriate clinical symptoms.

© RSNA, 2005

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