New perspective on median arcuate ligament syndrome. Case reports
Andrzej Smereczyński1, Katarzyna Kołaczyk1, Radosław Kiedrowicz2
1 Department for Genetics and Pathology of the Pomeranian Medical University, Self-education
Ultrasound Club, Szczecin, Poland
2 Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
Correspondence: Andrzej Smereczyński, ul. Wojciechowskiego 6A, 71-476 Szczecin, Poland;
e-mail: firstname.lastname@example.org, tel. +48 91 454 22 17
A large group of patients with significant asymptomatic or low-symptomatic coeliac trunk stenosis require deeper consideration. On angiography, CT and MRI, 10–24% of examined patients are found to have their coeliac trunk compressed by the median arcuate ligament of the diaphragm. The associated median arcuate ligament syndrome, which is also called coeliac trunk compression syndrome or Dunbar syndrome, is rarely fully symptomatic. It is estimated that there are up to 7% of patients with such a clinical presentation. An asymptomatic or low-symptomatic course of the disease in patients with the syndrome is mainly explained by a developed collateral circulation, particularly involving the arterial arcades of the head of pancreas. In such cases, CT angiography detects collateral circulation in 22–69.6% of examined patients. The present authors often observed coeliac trunk blood flow to normalise in a standing position. According to them, the main causative factor for this phenomenon is the deflection of the coeliac trunk and its compression against the aorta by a lowered left lobe of the liver. The researchers observed it in many individuals; in this study, 5 cases are presented.