Clinical Presentation

A 16-year-old patient presents with chronic abdominal pain and weight loss of 20 lbs.

(A) A three-dimensional volume-rendered computed tomographic angiogram (CTA) obtained during exhalation accentuates partial extrinsic compression (arrow) of the superior aspect of the celiac artery. Annotated is the left gastric artery (arrowhead). (B) Sagittal reformatted image obtained during exhalation again shows the extrinsic compression (arrow) of the superior aspect of the celiac artery. (C) Sagittal reformatted image obtained during inhalation shows resolution of the extrinsic compression (arrow).

Differential Diagnosis

• Median arcuate ligament syndrome (MALS): Likely, given isolated celiac involvement in a young patient with marked weight loss and postprandial pain.
  
• Accelerated atherosclerosis: Less likely due to underlying condition such as hyperlipidemia, given the appearance of the stenosis.