Paraligamentous Fat Necrosis Adjacent to the Falciform Ligament – A Rare Mimic of Acute Cholecystitis

Introduction Falciform ligament fat necrosis is an exceptionally rare cause of right upper quadrant pain and represents a localized form of intraperitoneal focal fat infarction (IFFI). Because of its proximity to the liver and gallbladder, it can clinically mimic acute cholecystitis. To date, only a few cases have been reported in the English-language literature [ 1 ] [ 2 ]. We describe a case of paraligamentous fat necrosis adjacent to the falciform ligament with typical CT features in an elderly woman, successfully managed conservatively. Coulier (2010) introduced the concept of IFFI and described its typical CT and ultrasound appearance. Awashra et al. (2024) presented one of the most comprehensive modern cases of falciform ligament necrosis, highlighting CT’s pivotal diagnostic role and the benign course under conservative management. This case report adds to the limited literature by describing the case of an elderly woman presenting with acute right upper quadrant (RUQ) pain and a positive Murphy’s sign – clinically suggestive of cholecystitis but radiologically proven to be falciform ligament fat necrosis. Publication History Received: 07 November 2025 Accepted after revision: 23 December 2025 Article published online: 30 January 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany