Exophytic spread of hepatobiliary disease via perihepatic ligaments: demonstration with CT and US

Eight cases of hepatobiliary disease located adjacent to or within the perihepatic ligaments (peritoneal reflections surrounding the liver) with exophytic spread along these ligaments (three abscesses from cholecystitis, two bilomas, two hepatic abscesses, and one hematoma from a ruptured hepatocellular carcinoma, with 16 ligamentous lesions: five in the hepatoduodenal ligament, four in the ligamentum teres, three in the falciform ligament, two in the gastrohepatic ligament, one in the transverse mesocolon, and one in the duodenocolic ligament) were studied with sonography and computed tomography. The locations of underlying diseases were the inferior aspect of the left lobe of the liver (three patients), the gallbladder (three patients), and the right hepatic duct (two patients). An understanding of the anatomic detail of the ligamentous attachments of the liver and the continuity of peritoneal ligaments is important in recognizing the ligamentous spread of hepatobiliary disease. This mode of spread of disease should be kept in mind in diagnostic imaging of the abdomen.