Superior Mesenteric Artery Thrombosis in a Patient With Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome (MALS) is a rare and controversial vascular compression syndrome. In this condition, the median arcuate ligament compresses the celiac artery, resulting in symptoms such as postprandial abdominal pain, vomiting, and weight loss. Its diagnosis is based on clinical findings in conjunction with supporting radiological features such as elevated flow velocities on Doppler ultrasound and focal indentation of the proximal celiac artery with the typical 'hooked' or 'J'-shaped appearance on conventional angiography or computed tomography angiography (CTA). Herein is the case of a 44-year-old female who presented with early satiety, postprandial abdominal pain, vomiting, and weight loss. A computed tomography mesenteric angiogram (CTMA) showed thickening of the median arcuate ligament with a hooked appearance of the celiac artery and thrombosis of the mid to distal superior mesenteric artery with associated ischemia of a short segment of the jejunum. Subsequent Doppler ultrasound demonstrated elevated peak systolic velocities within the celiac artery over the compressed segment, which varied with respiration (end-inspiration: 234.3 cm/s and end-expiration: 373.5 cm/s).