Median Arcuate Ligament Syndromedr walid agmy

61 years old man with epigastric pain and vomiting

The median arcuate ligament is a fibrous arch unites the diaphragmatic crura .

in some people, the ligament inserts low or celiac art originate high.

young patients (20–40 y), F : M

 CT angiograms: focal narrowing in the proximal celiac axis. inspiration and expiration 2ry signs poststenotic dilatation and collaterals.

ttt : surgery.

 angulations and narrowing of the proximal celiac axis.

Sagittal 3D image of a patient with epigastric pain

Sagittal (MIP) of a patient with recurrent abdominal pain reveals focal calcified plaque.

Prostglandin induced hyperostosisdr walid agmy

Caffey disease(ICH)• AD  .• subperiosteal bone formation• before 6 months, M:f 1:1• General hyperirritability, fever and anorexia,

painful, firm soft-tissue swelling.

PGE• TTT infants with cyanotic heart disease • cortical hyperostosis that mimics ICH.• PGE serum levels elevated • Indomethacin.

•  

DD

- Physiological in infant not more than 4 m.

- trauma.

- Hypervitaminosis A.

- scurvy

- prostaglandin E1 and E2 administration , 42% of infants for more than 30 days; this increases to 100% in more than 60 days.8

- infection (including syphilis)

- metastatic neuroblastoma.

Thank you