Purpose or Case Report: Background: Median Arcuate Ligament Syndrome (MALS) has a long and controversial past. Currently a diagnosis of exclusion, MALS is considered in patients suffering from functional abdominal pain who have typically had extensive prior workups. More common in slender, young women, MALS patients classically present with postprandial epigastric pain, nausea, weight loss, and occasional diarrhea. Since it was first described in 1963, debate has continued as to the pathophysiology of the disease with authors disagreeing whether symptoms are due to mesenteric ischemia and vascular steal phenomenon or compression of the celiac plexus and resulting neuropathy. The association with Postural Orthostatic Tachycardia Syndrome (POTS) in the pediatric population adds further speculation to the exact etiology.
Surgical treatment for MALS is becoming more common, particularly in the pediatric population. Recent technical advances in ultrasound and cross sectional imaging have led to an increased role of diagnostic radiologists in the diagnosis of MALS. Imaging provides an objective measurement in a sea of subjective complaints, with the results often dictating whether surgery is even considered.
Methods & Materials: Since February 2013, over 70 pediatric patients at our institution have had surgical treatment for MALS. We will provide a pictorial review based on our experiences.
Results: We will present a review of MAL anatomy, a summary of the current theories of the pathophysiology, a pictorial explanation of the pertinent findings, and a discussion of what we believe to be the ideal imaging techniques and significant values in pediatric patients based on both our experiences and the most recent literature.
Conclusions: As surgical intervention for MALS becomes more common, it is important for radiologists to be aware of the evolving techniques for for its evaluation.