A 50-year-old man with a history of alcohol and tobacco abuse presented with chronic and recurrent epigastric pain, weight loss, and weakness. The patient was known to receive antituberculous therapy for active pulmonary tuberculosis.
A contrast-enhanced abdominal computed tomography was performed. Axial images of portal phase demonstrated multiple wedge-shaped non-enhancing areas at the periphery of the spleen suggestive of splenic infarcts (Figure 1a). Splenic vein was permeable (Figure 1b). Axial and sagittal images of arterial phase revealed a small splenic artery related to severe stenosis and angulation of celiac axis caused by a thick soft tissue band (5 mm) anterior to the abdominal aorta creating a hooked appearance (Figure 2a, b). Coronal maximum intensity projection CT showed a prominent gastroduodenal artery with large collateral vessels around the pancreatic head (Figure 3). Median arcuate ligament syndrome causing splenic infarcts was retained and the patient was referred to vascular surgery service.