Member Area Login
If this is the first time you are logging into the ASA website or you can't remember your password, please select Get a new password below to be sent a link to your registered email address.
If this is the first time you are logging into the ASA website or you can't remember your password, please select Get a new password below to be sent a link to your registered email address.
Hey Jared, a completely valid question. It's always hard when a radiologist contradicts what your line thinking has always been.
The other members of the SIG group who contributed to this answer and myself broadly agree with you in the sense that raised velocities in the coeliac axis during full expiration can be associated with MALS.
One of our SIG members documents if there is significant PSV difference between inspiration and expiration in the Coeliac artery even if the PSV is slightly under 350cm/s, as getting the correct Doppler angle in the Coeliac axis can sometimes be difficult.
This is an extract from the Journal of medial ultrasound that backs that point up a bit that they suggested we steer your way. The study isn't the most recent but the principal still stands - Median Arcuate Ligament Syndrome 2003
''The median arcuate ligament is found at the T12-L1 level and bridges the crura of the diaphragm just anterior to the aorta. In patients with the median arcuate ligament syndrome, the celiac artery is compressed by the median arcuate ligament with expiration. With inspiration, the celiac artery descends in the abdominal cavity, resulting in a more vertical orientation of the celiac artery, which often relieves the compression. With the patient in the erect position, the celiac artery descends farther in the abdominal cavity, resulting in an even more vertical orientation of the celiac artery and relief of compression by the ligament''
Below is another extract from a much more recent publication which details some other nuances to be aware of that another member thought might be useful
Pellerito, John S., and Joseph F. Polak. Introduction to Vascular Ultrasonography. Seventh edition. Philadelphia, Pennsylvania: Elsevier, 2020. Print. Revxin Chapter 26 p 547-581
A potential pitfall for celiac artery stenosis is the median arcuate ligament (MAL) syndrome. The MAL is a fibrous band that extends from the diaphragmatic crura on either side of the aortic hiatus. The MAL usually passes just superior to the celiac artery. In some people, however, the MAL passes along the anterior margin of the celiac artery and may cause celiac artery compression during expiration. During the examination, the examiner may observe a characteristic change in the appearance of the celiac artery during different phases of the respiratory cycle. On expiration, the celiac artery assumes a hook-like appearance because of compression of the vessel by the ligament, and on inspiration, the artery takes a neutral, non-compressed course. With pulsed Doppler, mechanical compression of the celiac artery by the MAL is detected as increased PSV during expiration. On inspiration, a normal PSV is observed. Therefore inspiratory and expiratory velocity measurements should be obtained whenever MAL syndrome is suspected. Chronic compression of the celiac artery by the MAL may produce a fixed stenosis of the celiac artery with an elevated PSV that persists during inspiration.
This member (like myself) doesn't use a particular PSV but looks for the hook appearance in expiration, and a change in velocity. If a change with inspiration/expiration can't be produced you can also get them to stand which lower the mesentery and relieve the compression.
General consensus is that the radiologist has it backwards :)
Majority of credit for this answer goes to Dan Rae and Donna Oomens.
Hope this helps.