Head and Neck and Interventional Radiology Department, Antoine Lacassagne Cancer Research Institute,Nice, FranceCeliac trunk (CTr) anatomic variations are frequentand may be divided in two main subgroups: varia-tions of its origin and of its collaterals (Iezzi et al.,2008; Song et al., 2010).A 57-year-old woman underwent a multi-detectorrow computed tomography (MDCT) in our institutionto rule out sigmoid colon diverticulitis. MDCT findingsregarding colon inflammation were negative. How-ever, thorough analysis of the abdominal aortarevealed an anatomic variant of the CTr origin, atthe inferior thoracic aorta level, above the dia-phragm’s aortic hiatus. Its origin was normal withregards to the vertebral level, in relation with theT12-L1 vertebral disk (Rouvie`re, 1959b). Likewise,the diaphragm pilars originated from the lateral as-pect of the L2 vertebral body, as usually observed(Rouvie`re, 1959a). The median arcuate ligament(MAL), which connects the medial borders of the leftand the right diaphragmatic crura on either side ofthe aortic hiatus, was in relation to the lower L1 ver-tebral body. No anatomic variation regarding thenumber of lumbar vertebrae could be observed.The MDCT examination showed a CTr originatingfrom the thoracic aorta *10 mm above the aortic hi-atus of the diaphragm rather than from the abdomi-nal aorta (Fig. 1). The left gastric artery originatedfrom the CTr at the MAL level and all other CTrbranches (proper hepatic and splenic arteries) origi-nated below the diaphragm. The superior mesentericartery origin was located almost 10 mm below theCTr origin at MAL level. Neither arterial compressionnor stenosis were observed on the multiplanar andvolume rendering reformations.Interestingly, Lee et al. (2010) reported a supra-diaphragmatic origin of the CTr just above a congenitalaortic coarctation. The authors presumed that the highorigin of the common celiomensenteric trunk wasrelated to an aorta stenosis during foetal development.In this case, however, the thoracic aorta was normal,measuring 22 mm in diameter (Wolak et al., 2008).MAL may be typically located above or anterior tothe CTr (Manghat et al., 2008). This variability maybe explained by the diaphragm’s craniocaudalembryologic migration (Greer et al., 1999). Further-more, a high origin of the CTr may have a phyloge-netic analogy because in birds the CTr originates atthe oesophagus junction with the proventriculus, andsubsequently gives origin to the oesophageal artery(Haligur and Dulzer, 2010).The described variant may be clinically relevantbecause a low MAL or a high origin of the CTr maycause extrinsic arterial compression, also known asMAL syndrome (Manghat et al., 2008). The MAL syn-drome is due to insufficient blood supply and tran-sient episodes of mesenteric ischemia occurringduring digestion. The clinical manifestations of MALsyndrome include postprandial pain and body weightloss. However, some patients have a true CTr com-pression and remain asymptomatic (Karahan et al.,2007). During inhalation, the CTr moves down to theabdominal cavity and hence decreases its compres-sion. Conversely, CTr stenosis and related symptoms(e.g., postprandial epigastric pain) may aggravateduring exhalation. The pathogenesis of mesentericischemia remains incompletely understood. Mesen-teric ischemia could possibly be explained by post-prandial blood steal via collaterals linking the SMA tothe CTr, via the pancreaticoduodenal arteries, (Songet al., 2002; Karahan et al., 2007). Hypotheses alsoinclude neurogenic stimulation caused by compres-sion of the celiac ganglion and plexus, which mightinduce splanchnic vasoconstriction and subsequentischemia (Karahan et al., 2007).In this reported case, MAL was located 10 mmaway from its origin, inferior to the CTr. SMA took itsorigin from the aorta just at the MAL level. However,the patient did not have any clinical symptoms sus-pecting mesenteric ischemia. Neither CTr nor SMAcompression were observed.In conclusion, and from a clinical standpoint, suchan anatomic variant can precipitate arterial compres-sion via the MAL, although this was not the case withthis patient. Reformatted three- dimensional MDCT