Vishal Ghevariya, MD from the Icahn School of Medicine at Mount Sinai in Elmhurst, New York shares this video case “Celiac Artery Compression: EUS Evaluation” from the April issue.
A 51-year-old man presented for evaluation of abdominal discomfort. The discomfort was epigastric, nonradiating, accompanied by heartburn, and without specific aggravating/alleviating factors. He denied nocturnal/postprandial association and weight loss. His laboratory evaluation was within normal limits.
A CT scan revealed stenosis of celiac trunk with post-stenotic dilation measuring 8.6mm. CT scan and trans abdominal ultrasound could not delineate etiology of celiac compression clearly. EUS was performed at the time of EGD.
Figure 1. Sagital CT demonstrating celiac artery compression.
The median arcuate ligament arises from the crus of the diaphragm and travels cephalad to the celiac trunk. Celiac artery compression can occur due to low insertion of MAL or high celiac trunk take off. The median arcuate ligament syndrome (MALS) can result in chronic postprandial abdominal pain.
MALS is a rare condition with significant gastroenterological manifestations. Endoscopic ultrasound (EUS) evaluation in MALS is not described previously.
Our description provides a step-by-step guide to effectively evaluate MALS using EUS.
Watch this video case online here.
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