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 .

Epidemiology

They may be present in up to 20% of portal venous phase CT scans .

Pathology

It is thought to be due to variation in venous drainage. This region is usually drained by the vein of Sappey to the superior epigastric vein, then into the internal thoracic vein, and finally to the 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 (hepatic hot spot sign).

Location

The vast majority (~92%) are seen in the medial segment of the left liver adjacent to the falciform ligament (segment 4)

Other locations include

• both sides of falciform ligament: ~1.5%
• adjacent to porta hepatis: ~3%
• adjacent to gallbladder: ~3%

Shape

• triangular shape: ~66
• ovoid: ~19%
• nodular: ~15%