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Real-time ultrasound: Key factor in identifying celiac artery compression syndrome.

Tembey RA, Bajaj AS, Wagle PK, Ansari AS - Indian J Radiol Imaging (2015 Apr-Jun)

Bottom Line: The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome (CACS) is a rare entity, presenting clinically with postprandial abdominal pain and weight loss.The diagnosis is made on computed tomography (CT) angiography, which reveals extrinsic compression of the proximal part of the celiac artery by the median arcuate ligament, producing a characteristic hooked appearance.We report a case of the celiac artery compression syndrome, diagnosed by Doppler USG evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Imaging, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

ABSTRACT
The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome (CACS) is a rare entity, presenting clinically with postprandial abdominal pain and weight loss. The diagnosis is made on computed tomography (CT) angiography, which reveals extrinsic compression of the proximal part of the celiac artery by the median arcuate ligament, producing a characteristic hooked appearance. We report a case of the celiac artery compression syndrome, diagnosed by Doppler USG evaluation.

No MeSH data available.


Related in: MedlinePlus

Sagittal CT image shows focal narrowing at the origin of celiac artery
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Figure 1: Sagittal CT image shows focal narrowing at the origin of celiac artery

Mentions: A 27-year-old female patient presented with a one-year history of postprandial abdominal pain and weight loss. Her clinical and laboratory investigations did not reveal any significant abnormality. An USG examination of the abdomen done previously had not detected any pathology. In view of the unexplained abdominal complaints and weight loss, a CT (SOMATOM Definition Flash 128 slice dual source CT Scanner, manufactured by Siemens in Germany) scan of the abdomen and pelvis was advised. The CT identified a narrowing at the level of celiac artery origin, without any post-stenotic dilatation [Figure 1]. No atherosclerotic changes were observed in the aorta or any of its major branches. A Doppler USG was suggested to assess the hemodynamic significance of the narrowing. Real-time Doppler USG was first performed in a fasting status. The celiac artery flow velocities were examined in the supine and erect position and the angle between the celiac trunk and aorta was measured. The angle between the celiac trunk and aorta was 52.5° [Figure 2]. The celiac artery appeared narrowed at its origin and showed a turbulent flow [Figure 3A]. The peak systolic and end diastolic velocities in the supine position, at inspiration, were 201 and 61 cm/second [Figure 3B]. The peak systolic and end-diastolic velocities in the supine position, at expiration, were 323 and 136 cm/second [Figure 3C]. The peak systolic and end-diastolic velocities in the erect position were 99 and 35 cm/second [Figure 3D]. The elevated velocities in the supine position, at expiration, were reduced in the erect position. Also, the narrowed lumen of the celiac artery origin, in the supine position [Figure 4A], was reversed to a normal caliber in the erect position, with a more vertical orientation of the celiac axis [Figure 4B]. These findings raised a possibility of CACS. The aorta and superior mesenteric artery showed a normal B-mode and Doppler findings. The patient underwent a laparotomy. At laparotomy, it was observed that the median arcuate ligament was causing compression of the celiac axis [Figure 5A]. The ligament was divided and secured [Figure 5B]. Post-surgery, she has remained symptom-free and a Doppler USG examination performed seven days after surgery did not reveal any elevated velocity at the celiac artery origin in the supine position, on expiration. The peak systolic and end-diastolic velocities of the celiac artery, on expiration, post surgery, measured 132 and 44 cm/second, respectively [Figure 6].


Real-time ultrasound: Key factor in identifying celiac artery compression syndrome.

Tembey RA, Bajaj AS, Wagle PK, Ansari AS - Indian J Radiol Imaging (2015 Apr-Jun)

Sagittal CT image shows focal narrowing at the origin of celiac artery
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4419433&req=5

Figure 1: Sagittal CT image shows focal narrowing at the origin of celiac artery
Mentions: A 27-year-old female patient presented with a one-year history of postprandial abdominal pain and weight loss. Her clinical and laboratory investigations did not reveal any significant abnormality. An USG examination of the abdomen done previously had not detected any pathology. In view of the unexplained abdominal complaints and weight loss, a CT (SOMATOM Definition Flash 128 slice dual source CT Scanner, manufactured by Siemens in Germany) scan of the abdomen and pelvis was advised. The CT identified a narrowing at the level of celiac artery origin, without any post-stenotic dilatation [Figure 1]. No atherosclerotic changes were observed in the aorta or any of its major branches. A Doppler USG was suggested to assess the hemodynamic significance of the narrowing. Real-time Doppler USG was first performed in a fasting status. The celiac artery flow velocities were examined in the supine and erect position and the angle between the celiac trunk and aorta was measured. The angle between the celiac trunk and aorta was 52.5° [Figure 2]. The celiac artery appeared narrowed at its origin and showed a turbulent flow [Figure 3A]. The peak systolic and end diastolic velocities in the supine position, at inspiration, were 201 and 61 cm/second [Figure 3B]. The peak systolic and end-diastolic velocities in the supine position, at expiration, were 323 and 136 cm/second [Figure 3C]. The peak systolic and end-diastolic velocities in the erect position were 99 and 35 cm/second [Figure 3D]. The elevated velocities in the supine position, at expiration, were reduced in the erect position. Also, the narrowed lumen of the celiac artery origin, in the supine position [Figure 4A], was reversed to a normal caliber in the erect position, with a more vertical orientation of the celiac axis [Figure 4B]. These findings raised a possibility of CACS. The aorta and superior mesenteric artery showed a normal B-mode and Doppler findings. The patient underwent a laparotomy. At laparotomy, it was observed that the median arcuate ligament was causing compression of the celiac axis [Figure 5A]. The ligament was divided and secured [Figure 5B]. Post-surgery, she has remained symptom-free and a Doppler USG examination performed seven days after surgery did not reveal any elevated velocity at the celiac artery origin in the supine position, on expiration. The peak systolic and end-diastolic velocities of the celiac artery, on expiration, post surgery, measured 132 and 44 cm/second, respectively [Figure 6].

Bottom Line: The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome (CACS) is a rare entity, presenting clinically with postprandial abdominal pain and weight loss.The diagnosis is made on computed tomography (CT) angiography, which reveals extrinsic compression of the proximal part of the celiac artery by the median arcuate ligament, producing a characteristic hooked appearance.We report a case of the celiac artery compression syndrome, diagnosed by Doppler USG evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Imaging, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

ABSTRACT
The median arcuate ligament syndrome (MALS) or celiac artery compression syndrome (CACS) is a rare entity, presenting clinically with postprandial abdominal pain and weight loss. The diagnosis is made on computed tomography (CT) angiography, which reveals extrinsic compression of the proximal part of the celiac artery by the median arcuate ligament, producing a characteristic hooked appearance. We report a case of the celiac artery compression syndrome, diagnosed by Doppler USG evaluation.

No MeSH data available.


Related in: MedlinePlus