Presentation
The purpose of this case is to demonstrate the major ligaments of the liver on CT.
Patient Data

Two surfaces can be distinguished on the liver: a convex, diaphragmatic surface (facies diaphragmatica) and a flatter, lower (at the same time looking backwards and slightly to the left) visceral surface (facies visceralis). The two surfaces meet each other in front at an acute angle and thus create the sharp inferior margin. In the back and upper part of the liver the two mentioned surfaces merge into each other with a blunt convexity, especially in accordance with the thicker right lobe, so the border of the two surfaces can only be drawn artificially.
On the front surface of the liver, the ligamentum falciforme hepatis attached slightly to the right of the midline divides the liver into right (lobus hepatis dexter) and left (lobus hepatis sinister) lobes (anatomically). This separation of the lobes is only visible at the inferior margin, where a small sharp notch (incisura ligamenti teretis) marks the border. The falciform ligament connects the liver to the anterior abdominal wall and the diaphragm. It can be difficult to identify in normal circumstances.
The visceral surface of the liver is divided into four parts by an H-shaped groove system, which are also incorrectly called lobes (caudate and quadrate lobe). The system is formed by the impression of the inferior vena cava (posteriorly) and the gallbladder (anteriorly), the porta hepatis, the ligamentum teres hepatis (anteriorly) and the ligamentum venosum (posteriorly).
The ligamentum teres hepatis (round ligament) runs along the lower free edge of the falciform ligament and these divide the left lobe into medial (IV) and lateral segments (II/III). The teres hepatis (sagittally oriented) contains small amount of fat and a bundle of connective tissue corresponding to the former vena umbilicalis, which can also be seen on CT images as a narrow bundle running in the adipose tissue from the portal vein anteriorly and inferiorly to the navel.
The ligamentum venosum Arantii (Arantius' ligament) is the fibrous remnant of the ductus venosus, which in the fetal circulation shunts a portion of umbilical vein blood flow directly to the inferior vena cava. It continuous with the round ligament of liver. It is oriented in a coronal or oblique plane between the posterior aspect of the left lateral hepatic segment and the anterior aspect of the caudate lobe.
Typical focal hepatic steatosis can also be seen as hypodense (decreased contrast enhancement) geographic area along the falciform ligament in the ventral portion of the left lobe.
Case Discussion
Several ligaments are connected to the liver, but the most important ones, which can also be distinguished on CT/MR images, are the ligamentum falciforme hepatis on the frontal surface, and the ligamentum teres and ligamentum venosum on the visceral (inferior) surface of the liver.
The falciform ligament is not visible under normal conditions, but larger amounts of free abdominal fluid or free air make it visible (see falciform ligament sign).
A characteristic location for focal hepatosteatosis is adjacent to the falciform ligament in the left lobe.
Through the ligamentum teres hepatis, thin veins connect the portal vein through the paraumbilical veins with the vena cava. These act as an important portacaval anastomosis in severe portal hypertension, resulting in a caput medusae.