Angiography CT and Duplex-US findings in the compression of the celiac artery by the median arcuate ligament.

Congress:

ECR 2019

Poster Number:

C-2881

Type:

Educational Exhibit

Keywords:

Abdomen, Arteries / Aorta, Vascular, CT-Angiography, Ultrasound-Colour Doppler, Contrast agent-intravenous, Computer Applications-Detection, diagnosis, Education, Pathology, Obstruction / Occlusion

Authors:

F. A. Iannace¹, M. Coronella¹, R. FARINA², A. Conti¹, A. Conti³, C. Desiderio¹, P. V. Foti¹, S. Palmucci¹, A. Basile¹; ¹Catania/IT, ²Catania, IT/IT, ³Carlentini/IT

DOI:

10.26044/ecr2019/C-2881

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2881

Fig. 1: Angiographic CT. Reconstruction 3d volume rendering. The normal structure of...

Fig. 2: Angiographic CT. Reconstruction 3d volume rendering. The normal structure of...

Fig. 3: Angiographic CT. 3d volume rendering reconstruction, expiratory acquisition....

Fig. 4: Angiographic CT. 3d volume rendering reconstruction, expiratory acquisition....

Learning objectives

The aim of this work is to focus on the median arcuate ligament syndrome also known as Dunbar Syndrome, a rare cause of abdominal pain, and to show the main radiological findings (characteristics on imaging) of this pathology.

Background

Dunbar syndrome, or median arcuate ligament syndrome (MALS), is a condition caused by an extrinsic compression of the celiac trunk, and sometimes of the celiac plexus, by the median arcuate ligament (MAL). This is a fibrous band at the level of the Th12/L1 vertebral bodies, across the aortic hiatus, that connects the right and left diaphragmatic crura. However, the location of MAL is very variable. In fact, the celiac trunk, in 33% of cases, originates at the same level or above the MAL [1]. In...

Findings and procedure details

Imaging support is essential; diagnosis can be made through Duplex US and Angiography CT, that permit to show a lower implant of the arcuate ligament and the narrowing of the origin of celiac artery with a characteristic hooked appearance. A poststenotic dilatation and collateral vessels could be present in severe stenosis. A fundamental characteristic of this condition is the aggravation of stenosis following respiratory movements; the stenosis determined by the MAL, on the origin of the celiac trunk is more pronounced in expiration.[12]

Conclusion

Dunbar syndrome or MALS is a controversial condition and the debate of scientific community is still open. The radiologist should have a good knowledge and awareness of this disease because he plays a key role: thanks to radiological findings and clinical aspects he can do a correct differential diagnosis and address patients in right management, often curative.

Personal information

References

1. Ozdil Baskan MD*, Emre Kaya, MD, Fatma Zeynep Gungoren, MD, Cengiz Erol, MD.Compression of the Celiac Artery by the Median Arcuate Ligament: Multidetector Computed Tomography Findings and Characteristics.Canadian Association of Radiologists Journal 66 (2015) 272 e 276 2. Jeffrey Kah Keng Fong, Angeline Choo Choo Poh, Andrew Gee Seng Tan, Ranu Taneja.Imaging findings and clinical features of abdominal vascular compression syndromes.AJR:203, July 2014 3. Levin DC, Baltaxe HA. High incidence of celiac axis narrowing in asymptomatic individuals.AmJ Roentgenol Radium Ther Nucl Med1972;116:426–429 4. Dunbar...