Diseases and Conditions

Median arcuate ligament syndrome (MALS)

Diagnosis

There's no specific test to diagnose MALS. Your doctor will carefully examine you and ask questions about your symptoms and health history. The physical exam is often normal in people with MALS. Bloodwork and imaging tests help your doctor rule out other causes of stomach pain.

Tests used to rule out other conditions and diagnose MALS may include:

  • Blood tests. Comprehensive blood tests are done to check for problems with your liver, pancreas, kidneys and other parts of the body. A complete blood cell count shows your level of white and red blood cells. A high white blood cell count can mean you have an infection.
  • Ultrasound of your abdomen. This noninvasive test uses high-frequency sound waves to determine how blood is flowing through your blood vessels. It can show if the celiac artery is compressed, especially when breathing in and out deeply.
  • Upper endoscopy. This procedure, also called esophagogastroduodenoscopy (EGD), is done to view the esophagus, stomach and upper part of the small intestine (duodenum). During an EGD, the doctor gently guides a long, flexible tube with a camera on the end (endoscope) down your throat after numbing medication is applied. If needed, the doctor can take tissue samples (biopsy) during this procedure.
  • Gastric emptying studies. Compression of the celiac artery can slow the rate of stomach emptying. Gastric emptying studies are done to determine how fast your stomach empties its contents. Slow or delayed gastric emptying may be from other medical conditions.
  • Magnetic resonance imaging (MRI). An MRI uses powerful magnets and radio waves to produce detailed images of the body area being studied. Sometimes, dye is injected into a blood vessel to more clearly show how blood moves through your arteries and veins (magnetic resonance angiogram).
  • Computerized tomography (CT) of the abdomen. CT uses X-rays to create 3D images of the body area examined. An abdominal CT scan can show if the celiac artery is narrowed or blocked. If the diagnosis is still unclear after other imaging tests are done, your doctor may inject a dye into a blood vessel to highlight blood flow in your arteries and veins (CT angiogram).