Paediatric Imaging

Falciform ligament

the remnant of the peritoneal fold containing at its base the obliterated umbilical artery. It extends from the umbilicus and anterior abdominal wall to the anterior surface of the liver. It is only visible in pathological situations when outlined by gas or fluid, such as in neonatal pneumoperitoneum where it has a characteristic curvilinear appearance to the right of the midline in the upper abdomen (Fig.1). It may clearly be seen on CT with small amounts of free intraperitoneal gas, or outlined by fluid in the presence of massive ascites.

The obliterated umbilical vein may become recanalized in the presence of portal hypertension, acting as a collateral vessel from the portal venous system to the systemic veins of the anterior abdominal wall.

DG

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Fig.1

Supine radiograph of a neonate with a large pneumoperitoneum. The thin white curved structure overlying the right side of the lower thoracic spine is the falciform ligament (arrow).
Falciform ligament, Fig.1