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Median Arcuate Ligament Syndrome: Symptoms, Diagnosis & Treatment

Instructor: Misty Baker

Dr. Baker has a doctorate in podiatric medicine and practiced medicine in both the hospital and private practice atmosphere.

What is median arcuate ligament syndrome? In this lesson we will be discussing what median arcuate ligament syndrome is and the symptoms, diagnostic techniques, and treatment of this rare disorder.

Median Arcuate Ligament Syndrome

Mary presents to her primary care physician, Dr. Smarty, complaining of abdominal pain, or pain in her 'belly area', that has been present for over four months. She states that she mostly notices this pain after eating.

Upon questioning, Mary states that she did visit a 'quick care' clinic about two months ago and they diagnosed her with a stomach ulcer, gave her a prescription and provided her with a list of foods to avoid. Mary admits dutifully taking her provided prescription and avoiding the foods on the list provided, but, she states that her pain has not been relieved.

Upon further questioning, Mary admits that she has lost about 15 pounds over the last four months without even trying.

Mary is exhausted by this condition that she has been experiencing and is desperate for relief of pain!

Mary may be in luck. Dr. Smarty just confirmed the diagnosis of a rare disorder known as median arcuate ligament syndrome in another patient and feels that Mary may be experiencing similar symptoms associated with complications arising from this condition.

What is Median Arcuate Ligament Syndrome?

Median arcuate ligament syndrome (MALS) is also known as celiac artery compression syndrome. It is a rare disorder associated with the median arcuate ligament (hence the name) that is part of the diaphragm.

The diaphragm is the muscular partition, or separator, between the chest and the abdomen. Its job is to help us breathe. The median arcuate ligament is a muscular fibrous band that is part of the diaphragm, which aids in the inhalation of air into our bodies.

When a person has median arcuate ligament syndrome, the median arcuate ligament compresses, or presses, against something called the celiac axis. The celiac axis, which is comprised of the celiac artery, carries oxygenated blood to the areas of the stomach, liver, spleen, part of the lower esophagus, and the upper portions of the pancreas and duodenum. In simple terms, the celiac axis, including the celiac artery, is crucial for blood supply to the upper gut via the upper abdominal arteries.

When the celiac axis is compressed, as is the case in MALS, a drastic decrease in blood flow to the stomach and abdominal area occurs. This attributes to the cause of the abdominal pain.

It is important to understand that while a confirmed diagnosis MALS is not life-threatening, it can be debilitating, due to chronic pain, for those experiencing this disorder.

Symptoms of Median Arcuate Ligament Syndrome

An individual with MALS, like Mary, experiences some very non-specific symptoms that are usually misdiagnosed initially and treated as a multitude of other problems, such as a stomach ulcer, with no improvement.

There are three generalized symptoms that are common in the majority of patients diagnosed with this disorder:

1. Sharp, persistent and chronic pain in the upper abdomen that has been present for over two months

2. Pain in the abdomen after eating

3. Weight loss

Sometimes a 4th symptom can be detected in a patient affected with the disorder, but not every individual experiences this symptom:

4. Abdominal bruit , which is an abnormal sound, or murmur, made by the attempted movement of blood flowing through a blood vessel that is either blocked or narrowed. This can be detected by a physician with a stethoscope placed on the upper abdomen. With the stethoscope, Dr. Smarty may be able to hear a more turbulent flow of blood due to the compressed artery.

When a person with these symptoms presents to their physician and median arcuate ligament syndrome is suspected, the individual is usually referred to a vascular surgeon, who should be more familiar with this disorder versus a general practitioner, family physician, or urgent care physician.

Diagnosis of Median Arcuate Ligament Syndrome

Luckily for Mary, Dr. Smarty heard Mary's complaints and knew what steps to take to confirm whether or not Mary was suffering from MALS.

The diagnosis of median arcuate ligament syndrome can be confirmed by the following:

1. Physical Exam

2. Duplex Ultrasound of the diaphragm area and intestinal arteries - This test has the ability to measure peak flow volumes of blood within different sections of arteries therefore being able to detect when abnormal flood flow presents.

3. Medical resonance imaging (MRI) - With the detailed pictures of internal structures provided by MRI, any structural abnormalities can be easily detected such is the case with MALS.

4. Computed tomography (CT) angiogram and/or conventional angiogram of the area - When MALS is present, this test generally reveals a characteristic focal narrowing that resembles a hook appearance within the proximal celiac axis.

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