LAUSR

Median arcuate ligament syndrome (also known as celiac artery compression syndrome) was first described by Harjola [1]. It is an uncommon disorder due to compression of the proximal celiac artery by the median arcuate ligament, a fibrous band bridging the left and right diaphragmatic crura. The classically described hooked appearance of the celiac artery on CT is a useful sign to differentiate median arcuate ligament syndrome from other causes of celiac artery narrowing such as atherosclerosis [2]. This characteristic ‘hooking’ is formed by initial downsloping course and subsequent superior concave indentation of the proximal celiac trunk. The resulting deformity of the artery resembles a fish hook (Fig. 1). Sagittal reformatted images and 3D images by volume rendering are best for demonstrating this finding (Fig. 2A, B). The diagnosis of median arcuate ligament syndrome requires a combination of both clinical and radiological features [1, 2]. Celiac compression by the median arcuate ligament can occur in up to 24% of asymptomatic subjects [3] but only a small portion of patients would develop typical symptoms like post-prandial epigastric pain and weight loss. Other ancillary CT features that suggest a hemodynamically significant stenosis include poststenotic dilatation and formation of collateral vessels from superior mesenteric artery branches, e.g. via the pancreaticoduodenal arcade (Fig. 3). Fig. 1. A fish hook. Available at: https://commons. wikimedia.org/wiki/File:Fish-hook.JPG. Photo courtesy of AntanO. Accessed 12 May 2017.