Bauman Parker,  Mcdaniel Janice

Final Pr. ID: Poster #: CR-034

A 17-year-old female presents with the chief complaint of recurrent epigastric pain following the diagnosis of median arcuate ligament syndrome (MALS) confirmed via ultrasound duplex and computed tomography angiography. Subsequent laparoscopic median arcuate ligament release and resection of celiac nerve plexus were performed. The patient initially had complete resolution of pain; however, the same type of epigastric pain recurred with no sonographic evidence of recurrent MALS. This prompted the use of a celiac plexus block for diagnostic and therapeutic purposes. Using a one-sided posterior approach, the expected location of the celiac nerve plexus was localized using 3-dimensional cone-beam computed tomography-guided imaging. Using intermittent fluoroscopy with laser and iGuide graphic overlay the needle was incrementally advanced; to confirm the periaortic location of the needle tip a small amount of dilute contract was injected. Then, 80 mg (40mg/mL) of triamcinolone and 20 mL of 0.5% bupivacaine hydrochloride was administered into the periaortic space. The patient had a complete resolution of pain for two weeks. To obtain long-term pain relief, the process was repeated with an injection of 10 mL of 99% ethanol to effectively ablate the celiac nerve plexus, along with 20 mL of bupivacaine liposome. At 1 month and 3 months post-injection, the patient reports a significant reduction in epigastric pain (0-1 out of 10) following the procedure and reports being pleased she had the procedure. This case expands the use of computed tomography-guided celiac plexus ablation by showing effectiveness in reducing epigastric pain in a pediatric patient with a prior MALS diagnosis. Read More

Authors:  Bauman Parker , Mcdaniel Janice

Keywords:  Cone-Beam CT Guidance, Paediatric Radiology, Median Arcuate Ligament Syndrome

Bandarkar Anjum,  Otero Hansel

Final Pr. ID: Poster #: SCI-076

The Median Arcuate Ligament Syndrome (MALS) is a diagnosis of exclusion. It is a condition characterized by abdominal pain due to compression of celiac artery by the median arcuate ligament.
1. The purpose of this study is to review a single institutional experience in screening and diagnosing MALS in the pediatric population with emphasis on the diagnostic accuracy of ultrasound (US) Doppler against additional imaging and follow up.
2. We also describe our technical approach of performing Doppler US in suspected MALS and various diagnostic criteria. Read More

Authors:  Bandarkar Anjum , Otero Hansel

Keywords:  Median Arcuate ligament syndrome, Doppler Ultrasound, Postural Orthostatic tachycardia syndrome

Llorens Carlos,  Scholz Stefan,  Tadros Sameh,  Squires Judy

Final Pr. ID: Poster #: EDU-084

Vascular compression syndromes of the abdomen, including median arcuate ligament syndrome, superior mesenteric artery syndrome, and nutcracker syndrome, are challenging clinical entities with imaging findings that may be confusing. Imaging plays a decisive role in the diagnostic algorithm in children because clinical findings alone can be nonspecific and functional abdominal pain is common. Findings of angiography, CT, MRI, and fluoroscopy for these syndromes have been widely described and provide useful information to aid in the diagnosis of these syndromes. Sonographic findings have also been described in the literature, but are less known and possibly perplexing, with variable diagnostic criteria in children. Ultrasound is therefore likely underutilized in evaluating these abnormalities despite its ability to provide anatomic, physiologic, and most importantly, dynamic information in a cost-effective manner without the use of ionizing radiation. The purpose of this exhibit is to review the clinical features of vascular compression syndromes in the abdomen, review ultrasound imaging findings and discuss diagnostic criteria. Read More

Authors:  Llorens Carlos , Scholz Stefan , Tadros Sameh , Squires Judy

Keywords:  median arcuate ligament syndrome, superior mesenteric artery syndrome, nutcracker syndrome