Hepatic pseudolesion near falciform ligament
Hepatic pseudolesions near the falciform ligament show abnormal attenuation without mass effect. They may be seen on contrast-enhanced CT scans as either a region of high or low attenuation relative to the rest of the liver. They are typically located in the medial segment of the left lobe of the liver near the falciform ligament. Equivalent features have also been described on MRI and nuclear scintigraphy 4.
They may be present in up to 20% of portal venous phase CT scans 7,9.
It is thought to be due to variation in venous drainage. This region is usually drained by the vein of Sappey to superior epigastric vein, then into the internal thoracic vein, and finally to superior vena cava (SVC).
Some of these lesions result from focal fatty sparing.
In the case of SVC obstruction, these veins will dilate as a collateral pathway and the pseudolesion will show increased enhancement ("hot quadrate lobe").
The vast majority (~92%) are seen in the medial segment of left liver lobe adjacent to falciform ligament (segment IV)
Other locations include 6
- both sides of falciform ligament: ~1.5%
- adjacent to porta hepatis: ~3%
- adjacent to gallbladder: ~3%
- triangular shape: ~66
- ovoid: ~19%
- nodular: ~15%
- 1. Urban BA, McGhie PA, Fishman EK. Helical CT: diagnostic pitfalls of arterial phase imaging of the upper abdomen. AJR Am J Roentgenol. 2000;174 (2): 455-61. doi:10.2214/ajr.174.2.1740455 - Pubmed citation
- 2. Mandell J. Core Radiology. Cambridge University Press. (2013) ISBN:110729276X. Read it at Google Books - Find it at Amazon
- 3. Temizöz O, Genchellac H, Yekeler E et-al. CT-angiographic demonstration of hepatic collateral pathways due to superior vena cava obstruction in Behçet disease. Diagn Interv Radiol. 2009;16 (4): 302-5. doi:10.4261/1305-3825.DIR.2174-08.2 - Pubmed citation
- 4. Spelle L, Soyer P, Rondeau Y et-al. Nontumorous hepatic pseudolesion around the falciform ligament: prevalence on gadolinium chelate-enhanced MR examination. AJR Am J Roentgenol. 1997;169 (3): 795-9. doi:10.2214/ajr.169.3.9275899 - Pubmed citation
- 5. Soyer P, Devine N, Somveille E et-al. Hepatic pseudolesion around the falciform ligament: prevalence on CT examination. Abdom Imaging. 1996;21 (4): 324-8. Pubmed citation
- 6. Koseoglu K, Ozsunar Y, Taskin F et-al. Pseudolesions of left liver lobe during helical CT examinations: prevalence and comparison between unenhanced and biphasic CT findings. Eur J Radiol. 2005;54 (3): 388-92. doi:10.1016/j.ejrad.2004.07.016 - Pubmed citation
- 7. Genchellac H, Yilmaz S, Ucar A et-al. Hepatic pseudolesion around the falciform ligament: prevalence, aberrant venous supply, and fatty infiltration evaluated by multidetector computed tomography and magnetic resonance imaging. J Comput Assist Tomogr. 2007;31 (4): 526-33. doi:10.1097/01.rct.0000284387.68449.ec - Pubmed citation
- 8. Ohashi I, Ina H, Gomi N et-al. Hepatic pseudolesion in the left lobe around the falciform ligament at helical CT. Radiology. 1995;196 (1): 245-9. doi:10.1148/radiology.196.1.7784576 - Pubmed citation
- 9. Ucar A, Sahin D, Bulakci M et-al. Prevalence of hepatic pseudolesions around the falciform ligament in a paediatric population. J. Int. Med. Res. 2012;39 (4): 1490-6. Pubmed citation