Falciform ligament

Fig. 2.1 Views of the liver anterior, posterior, inferior. (LL = left lobe, RL = right lobe, D = diaphragm, GB = gall bladder, FLV = fissure for ligamentum venosum, RL = round ligament (= lig. teres), IVC = inferior vena cava, FL = falciform ligament)...

Focal accumulation of fat is predominantly found either near to the falciform ligament of the liver or to the por-... 

Position 2 Inspection of the right upper abdomen with the upper body raised in left rotation (= right lobe of liver, gall bladder, round ligament, falciform ligament, duodenum). 

Fig. 7.7 Congested lymphatic vessels in the area of the medial part of the right lobe of liver (insertion of the left falciform ligament can be clearly identified) with partial vessel wall segmentation. Here in chronic toxic hepatitis...

Up to now such (oval) fat deposition has been interpreted by the radiologist as being a falciform ligament (s. fig. 8.1) - this viewpoint must now be reconsidered. It should in any case be noted that the falciform ligament is totally devoid of fat ... 

Fig. 8.1 Frequently recorded reduction in density in the area of the falciform ligament (here 11.4 HU) resembling fatty tissue (possibly a round ligament ) (s. pp 127, 132)...

This technique, as described by M. Royer in 1952, is a PTC variant. Although it entails fewer complications, the success rate is also reduced, since the length of the intrahepatic puncture channel is only 3 cm. The puncture is performed at a point approx. 3 cm away from the falciform ligament and 5 cm cranial to the edge of the liver, with a puncture angle of 45°. 

Fig. 16.4 Lymphostasis in the region of the liver capsule of the left liver lobe (lower part) and the falciform ligament...

Fig. 37.29 Laparoscopic staging metastases at the falciform ligament in oesophageal carcinoma...

The fiver is divided into left and right anatomical lobes by the falciform ligament, an anterior extension of the peritoneal folds that connects the fiver to the diaphragm and anterior abdominal wall (Figure 47-1). Two smaller lobes are found on the posterior surface (caudate lobe) and the infe-... 

Ligamentum teres Right and left leaves of falciform ligament... 

Fig. 1.38. Pneumoperitoneum complicating necrotizing enterocolitis. Supine in a 1-month-old premature infant radiograph shows intramural gas in the small howel and free intraperitoneal air secondary to howel perforation. The central lucency and the falciform ligament are observed...

Fig. 5.11a,b. Pneumoperitoneum in an infant with ileal perforation. Free air outlining the G1 tract. Note the visualized falciform ligament, a Supine film with football sign b cupula sign , free air under the cardiac silhouette... 

Perforation is most reliably demonstrated on abdominal plain films if taken in two directions. A supine film (Fig. 5.11) will demonstrate an abnormal lucency in the upper abdomen with gas outlining the right lobe of the liver, both sides of the wall of the stomach and bowel loops. The falciform ligament may be visible in the upper abdomen. In the newborn, a left-side down decubitus film will demonstrate free air between the liver and peritoneal wall, which is almost certainly impossible to confuse with intraluminal air. In case of an unstable neonate, a cross-table lateral view is preferred, but it can mask free air behind intraluminal air, unless the so-called triangle sign (Fig. 5.12) is present. 

Fig. 5.1a-d. Sequential CT scan through the liver with Couinaud s segments divided and numbered. RHV, right hepatic vein MHV, middle hepatic vein LHV, left hepatic vein IVC, inferior vena cava RPV, right portal vein LPV, left portal vein FL, falciform ligament... 

Interpretation of lOUS includes the sonographic information combined with intraoperative inspection and palpation. Surgical mohilisation of the liver with dissection of the falciform ligament is of great help, as it provides easy access to all parts of the organ. Complete visualisation of the liver including its posterior aspect requires insonation from the anterior, lateral and posterior approach. The examination usually takes 10-15 min. 

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