Median arcuate ligament syndrome
 Discussion of Median arcuate ligament syndrome
- Median arcuate ligament syndrome refers to clinically significant celiac axis compression by the median arcuate ligament.
- The median arcuate ligament is a fibrous arch that unites the left and right diaphragmatic crura on either side of the aortic hiatus.
- The ligament usually passes superior to the origin of the celiac axis.
- In some people, the ligament inserts low and crosses the proximal portion of the celiac axis, causing compression and sometimes resulting in abdominal pain.
- Surgical treatment is controversial: Because surgical ligation of the constricting median arcuate ligament has been performed with only variable success, many surgeons no longer believe the median arcuate ligament syndrome as a real clinical entity.
 Imaging Findings for Median arcuate ligament syndrome
 Conventional Angiography
- When the median arcuate ligament passes anterior to the celiac axis, a characteristic superior indentation is noted along the proximal celiac axis, usually about 5 mm from its origin at the abdominal aorta.
- Any compression caused by this indentation typically is less apparent during inspiration, when the celiac axis assumes a more caudal orientation as the lungs expand.
- During expiration, compression of the celiac axis typically increases
- Isolated compression of the celiac axis during expiration may not be clinically significant.
- CT is typically performed during inspiration.
- Typically, the sagittal plane is optimal for visualizing the proximal portion of the celiac axis, and in many cases, 3D imaging also allows identification of the actual median arcuate ligament.
- Characteristic focal narrowing in the proximal celiac axis. The focal narrowing has a characteristic hooked appearance, which can help distinguish this condition from atherosclerotic disease.
 See Also
 External Links
 References for Median arcuate ligament syndrome
- Karen M. Horton, Mark A. Talamini, and Elliot K. Fishman. Median Arcuate Ligament Syndrome: Evaluation with CT Angiography. RadioGraphics 2005 25: 1177-1182