Median Arcuate Ligament Syndrome (MALS)

Kali, I first need to say thank you for being involved with all of our problems with MALS. Secondly; I need to ask, how dire is MALS symptoms for everyone. I've been diagnosed after physical exam, CT angiogram for anatomy only, and a celiac plexus block. It seemed like we would need more tests than this, other than history of mild gastric emptying; 14% gallbladder function and removal. But, Dr. Hsu said that's all we need. I feel like my symptoms are much more dire than a the anatomy of this issue. I almost feel like a completely detached a ligament in my diaphragm and I'm suffocating. Now, I had a chest x-ray after my block and I assume that means my diaphragm is properly attached. But, How does MALS just happen out of the blue? I would think the geometry would have needed to change to cause the agrivation and restriction of the Celiac artery.

Kali, I first need to say thank you for being involved with all of our problems with MALS. Secondly; I need to ask, how dire is MALS symptoms for everyone. I've been diagnosed after physical exam, CT angiogram for anatomy only, and a celiac plexus block. It seemed like we would need more tests than this, other than history of mild gastric emptying; 14% gallbladder function and removal. But, Dr. Hsu said that's all we need. I feel like my symptoms are much more dire than a the anatomy of this issue. I almost feel like a completely detached a ligament in my diaphragm and I'm suffocating. Now, I had a chest x-ray after my block and I assume that means my diaphragm is properly attached. But, How does MALS just happen out of the blue? I would think the geometry would have needed to change to cause the agrivation and restriction of the Celiac artery.

Hi guys. I am a 23 year old female! I have been experiencing lots of symptoms over the last 6-7 months and have got no answers. It started out in December with very horrible abdominal pain that radiated to my back, nausea,fatigue, SOB and vomiting. After being seen in the ER that night they did an ultrasound and blood work to rule out gall bladder issues .Gall bladder came back fine. Was prescribed narcos and told to follow up with a primary care provider. While following up with my primary care doctor she did additional blood work and thoroughly checked my liver and what not. Everything came back perfect. She then referred me to see a GI specialist and he ordered an Endoscopy. Ever since the beginning of December I lost 15lbs, could barely eat and had nausea for 3 months straight. The Endoscopy was done in the beginning of February. Results came back with mild gastritis and possible gastroproieses. The shortness of breath would come and go with the abdominal pain. The only way to relieve the pain was medication and laying flat on my back while stretching out. Was also referred to a Pulmonolgist to rule out asthma and anything breathing issues associated with the SOB. Here I am today with no answers.. but I know something isn't right with my body. Pain is right under my sternum and feels like there is a rubber band pinching or holding something. Next steps I believe my GI DR wanted to do are imaging on my abdomen area and being seen by a cardiologist. Seems like a lot of my symptoms are similar to your guys symptoms! Im sorry you guys all have to go through this. It really can put you down and make you want to feel like doing nothing. I am hoping to get answers soon. Should I mention MALS to my DR or just let him run his tests and see? I feel like a lot of missed diagnoses go missed sometimes.

Thanks guys!

Thanks for the quick response! I will definitely be straight forward. As to what you were saying about the autonomic nervous system that totally makes sense for the palpitations and shortness of breath. Do you also have a burning or warm feeling under the sternum? My pain comes and goes a lot too. It sucks that to see all these specialist it takes weeks to get in. I am so ready to be out of pain and being uncomfortable..

Thanks for the quick response! I will definitely be straight forward. As to what you were saying about the autonomic nervous system that totally makes sense for the palpitations and shortness of breath. Do you also have a burning or warm feeling under the sternum? My pain comes and goes a lot too. It sucks that to see all these specialist it takes weeks to get in. I am so ready to be out of pain and being uncomfortable..

Hi guys. I am a 23 year old female! I have been experiencing lots of symptoms over the last 6-7 months and have got no answers. It started out in December with very horrible abdominal pain that radiated to my back, nausea,fatigue, SOB and vomiting. After being seen in the ER that night they did an ultrasound and blood work to rule out gall bladder issues .Gall bladder came back fine. Was prescribed narcos and told to follow up with a primary care provider. While following up with my primary care doctor she did additional blood work and thoroughly checked my liver and what not. Everything came back perfect. She then referred me to see a GI specialist and he ordered an Endoscopy. Ever since the beginning of December I lost 15lbs, could barely eat and had nausea for 3 months straight. The Endoscopy was done in the beginning of February. Results came back with mild gastritis and possible gastroproieses. The shortness of breath would come and go with the abdominal pain. The only way to relieve the pain was medication and laying flat on my back while stretching out. Was also referred to a Pulmonolgist to rule out asthma and anything breathing issues associated with the SOB. Here I am today with no answers.. but I know something isn't right with my body. Pain is right under my sternum and feels like there is a rubber band pinching or holding something. Next steps I believe my GI DR wanted to do are imaging on my abdomen area and being seen by a cardiologist. Seems like a lot of my symptoms are similar to your guys symptoms! Im sorry you guys all have to go through this. It really can put you down and make you want to feel like doing nothing. I am hoping to get answers soon. Should I mention MALS to my DR or just let him run his tests and see? I feel like a lot of missed diagnoses go missed sometimes.

Thanks guys!

Hi guys. I am a 23 year old female! I have been experiencing lots of symptoms over the last 6-7 months and have got no answers. It started out in December with very horrible abdominal pain that radiated to my back, nausea,fatigue, SOB and vomiting. After being seen in the ER that night they did an ultrasound and blood work to rule out gall bladder issues .Gall bladder came back fine. Was prescribed narcos and told to follow up with a primary care provider. While following up with my primary care doctor she did additional blood work and thoroughly checked my liver and what not. Everything came back perfect. She then referred me to see a GI specialist and he ordered an Endoscopy. Ever since the beginning of December I lost 15lbs, could barely eat and had nausea for 3 months straight. The Endoscopy was done in the beginning of February. Results came back with mild gastritis and possible gastroproieses. The shortness of breath would come and go with the abdominal pain. The only way to relieve the pain was medication and laying flat on my back while stretching out. Was also referred to a Pulmonolgist to rule out asthma and anything breathing issues associated with the SOB. Here I am today with no answers.. but I know something isn't right with my body. Pain is right under my sternum and feels like there is a rubber band pinching or holding something. Next steps I believe my GI DR wanted to do are imaging on my abdomen area and being seen by a cardiologist. Seems like a lot of my symptoms are similar to your guys symptoms! Im sorry you guys all have to go through this. It really can put you down and make you want to feel like doing nothing. I am hoping to get answers soon. Should I mention MALS to my DR or just let him run his tests and see? I feel like a lot of missed diagnoses go missed sometimes.

Thanks guys!

I have a very similar situation and I insisted to my doctor that we do a test for MALS. There are a couple of ways to start. One is a very specific ultrasound where they have you breathe out while checking your velocities (if there is a compression of the celiac artery, they will see it with the exhalation). Other tests might include a CTA with contrast. My tests came back positive for MALS and I am seeing a vascular surgeon this week. In the meantime, my understanding is that the breathing, and in my case, heart palpitations (and slow digestion, and possibly even malnutrition), are stemming from the fact that I have a very sensitive autonomic nervous system and the nerves between the celiac artery and the ligament that is compressing it, are irritated themselves and are irritating my autonomic nervous system (causing all of those other issues). A good cardiologist, or even your PCP could explain the autonomic nervous system far better than I, but I hope I have given you something to go on.