The falciform ligament in the echocardiographic diagnosis of ascites

The purpose of this study was to show that the falciform ligament (FL) is an important finding on transthoracic echocardiography (TTE) in patients with ascites.

It is difficult to determine the cause of echo-free spaces around the heart. When an echo-free space is seen anterior to the right ventricle, the identification of the FL helps to distinguish ascites from pericardial effusions, pleural effusions, and pericardial cysts.

TTE was performed with a 3-MHz multiplane transducer connected to an ultrasound system. Standard TTE and Doppler flow measurements were performed following the American Society of Echocardiography guidelines. A total of 32 patients with ascites were studied.

In all 32 patients with ascites noted on clinical examination and documented with abdominal ultrasound, magnetic resonance imaging, computerized tomography, paracentesis, or a combination of these, the FL was identified in the subdiaphragmatic view on TTE examination.

The FL can be readily visualized on TTE in the subdiaphragmatic view and can aid in the differential diagnoses of translucent space around the right heart border and the liver. The presence of the FL in this echolucent space denotes ascites.