more acronyms: MALS (median arcuate ligament syndrome)

30 Jun

RAGING HYPOTHETICAL:

Your next patient is a 63 M with intermittent abdominal pains with this being his worst and longest case.  You’re worried about  vascular pathology such as dissection or ischemia, and end up deciding to order a CTA.  

 

Your patient gets the CTA, and the read comes back as this:

  • median arcuate ligament syndrome (MALS), with high-grade compression/stenosis of the celiac trunk.

 

So what does actually this mean?

 

QUICK PEARLS:

MALS or Celiac Artery Compression (CAC) results from external compression of the celiac artery by the median arcuate ligament

an unusual cause of visceral ischemia.

more common in younger adults and women than men.

usually associated with weight loss

pain is often post-prandial.

Often an epigastric bruit can be heard on exam.

Some compression of the celiac artery is common even in patients without the syndrome, so making a definitive diagnosis can be difficult.

Referral to a vascular surgeon is an appropriate step.

 

Submitted by J. Stone.

 

References: (Rapp, Joseph H. , MacTaggart, Jason. Chapter 34. Arteries – in Current diagnosis and treatment : Surgery 13th ed. 2010); picture

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