CTICasesMedian Arcuate Ligament Syndrome
[...]. Median Arcuate Ligament Syndrome. CTICases. Published September 11, 2026. https://cticases.com/c/ef7bd
Imaging findings
A woman with a normal chest radiograph presented with abdominal pain and weight loss, with symptoms sometimes related to taking a deep breath. CT showed narrowing at the origin of the celiac artery, where the median arcuate ligament, the brief junction of the right and left crura anterior to the descending aorta just above the celiac takeoff, crosses the vessel. Doppler ultrasound measured velocities at rest and again on deep inspiration and showed an increased gradient across the narrowing with inspiration along with post-stenotic dilatation, meeting the vascular criteria for the syndrome. She proceeded to surgical release.
Key takeaways
The mechanism depends on the crura being mobile: as the diaphragm descends on inspiration, the crural anastomosis in front of the aorta is pulled caudally toward the lumbar vertebral bodies and impinges on the celiac origin. Diagnosis therefore rests on respiratory-phase Doppler velocity criteria rather than on a single static image, since a degree of celiac narrowing is a common incidental finding. The presenters were openly skeptical that the syndrome is as real as it is diagnosed, noting that clinicians reach for it in patients with nonspecific epigastric pain and weight loss and that this patient continued to have problems after surgery.
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