Fact-sheet: Celiac trunk compression by median arcuate ligament
Updated on 09/17/2021 at 12:16 PM
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Definition
Compression of the origin of the celiac trunk by the median arcuate ligament, caused by a variant origin of the celiac trunk in relation to the median arcuate ligament, favored by:
- a low-lying or hypertrophied median arcuate ligament
- a high origin of the celiac trunk
- an anomalous course of the celiac trunk
- more rarely, nerve compression: celiac plexus, neuroma, fibrosis
Clinical features
- Female predominance (4/1), 20-50 years
- Often asymptomatic and thus an incidental finding (prevalence approximately 10%)
- Post-prandial epigastric pain
- Sometimes: nausea, vomiting, weight loss
- Systolic bruit on auscultation in the epigastric region, increased at end-expiration
Ultrasound
Duplex ultrasound: Stenosis of the origin of the celiac trunk worsening on forced expiration.
Systolic velocities > 2 m/sec --> Stenosis > 70%.
Flow reversal in the gastroduodenal artery or hepatic artery (supplied by the superior mesenteric artery via the pancreaticoduodenal arcade)
CT
CT angiography:
- Non-atheromatous stenosis of the origin of the celiac trunk
- Notch (hooked appearance) at the origin of the celiac trunk
- Post-stenotic dilatation
- Collateral circulation
- Look for arterial variants (right hepatic artery and others)
- Collateral supply from the superior mesenteric artery: pancreaticoduodenal arcades and dorsal pancreatic artery, with high flow leading to aneurysm formation