Median arcuate ligament syndrome with predominantly respiratory manifestatios

Abstract

One of the causes of respiratory disorders in young people may be visceral circulation chronic violation in median arcuate ligament syndrome (MALS). The aim of the study was to assess the clinical significance of respiratory disorders in establishing the MALS diagnosis in order to determine the necessary management tactics for patients with this pathology. Materials and methods. 49 MALS patients were examined, the main symptoms being respiratory disorders, such as shortness of breath, difficult inhaling and/or exhaling, and others. The median age was 24.7±0.9 years, females predominated (60%).
The diagnosis of MALS was confirmed by clinical data, the results of transabdominal ultrasound duplex scanning of the abdominal aorta and its visceral branches using respiratory and orthostatic tests. Subsequent comparative analysis of the characteristic respiratory symptoms’ severity before and after surgery (decompression of the celiac trunk) was performed. Research results. 10 main symp- toms of respiratory disorders were identified in patients under study, the frequency of each ranged from 31% to 50%, in most patients they were combined. Spirometry in
these patients did not reveal any changes in both static lung volumes or airway patency. Bronchodilation reversibility tests were negative. Chest X-ray and/or computed tomography did not reveal any visible changes. During examination, hemodynamically significant compression stenosis of the celiac trunk (CT) was observed in all patients. For all patients, auscultation of the abdominal cavity and detection of systolic murmur were performed.
Confirmation of the diagnosis was based on ultrasound of the unpaired visceral arteries with color mapping, imaging of the severity of CT stenosis, nature and speed of blood flow. An ultrasound study of the diaphragm func- tion revealed a direct statistically significant relationship between the diameter of the orifice of the CT and the amplitude of the respiratory displacement of the diaphragm dome during quiet breathing (r=0.58), the amplitude of the respiratory displacement of the diaphragm dome during forced breathing (r=0.64), and the thickening frac- tion of the muscular part of the diaphragm, with quiet breathing (r=0.61) and thickening fraction of the muscu- lar part of the diaphragm during forced breathing (r=0.46, not significant, trend). The given correlation coefficients were estimated as a medium-strength relationship, i.e., the narrower the CT mouth, the worse the diaphragm kinetics. In most patients, after surgical treatment, decompression of the celiac trunk, the clinical manifestations of respiratory disorders resolved, which may indicate their connection with diaphragmatic compression stenosis of the CT. Conclusion. The clinical manifestations of respi- ratory disorders in MALS, in most cases, are similar to the symptoms of bronchial asthma, which often led to the establishment of an erroneous diagnosis and ineffectiveness of the prescribed therapy. This theoretically and clinically important circumstance must be taken into account in the differential diagnosis of celiac trunk compression syndrome in combination with respiratory disorders. In the presence of hemodynamically significant compression stenosis of the CT and respiratory disorders, it is advisable to perform surgical intervention.