Beyond embryological remnants: imaging of ligamentum teres hepatis and falciform ligament pathologies

The falciform ligament and the ligamentum teres hepatis (LTH) have historically been regarded as embryological remnants with minimal clinical significance. However, their complex anatomical relationships with the liver, diaphragm, retroperitoneum, and abdominal and thoracic walls make them susceptible to various pathological conditions. This review highlights the anatomy of the falciform ligament and the LTH, their significance in surgical procedures, and pathologies of these structures on cross-sectional imaging. We will discuss the normal anatomy, congenital variations, inflammatory and infectious processes, neoplastic conditions, and vascular anomalies affecting these structures. Recognition of the imaging characteristics of the falciform ligament and the LTH pathologies is crucial for accurate diagnosis and management. CRITICAL RELEVANCE STATEMENT: Recognition of the falciform ligament and the ligamentum teres hepatis pathologies is critical for accurate diagnosis, surgical planning, and avoiding misinterpretation of pseudolesions. Cross-sectional imaging helps identify pathologies of these structures, guide management, and avoid unnecessary interventions. KEY POINTS: The falciform ligament and the ligamentum teres hepatis have critical anatomical relationships that make them susceptible to various pathologies. Cross-sectional imaging is essential for the diagnosis of pathologies affecting these structures. Pseudolesions associated with these structures can mimic true liver pathology on CT and MRI.