Accumulation of triglycerides within hepatocytes

Diffuse hepatic steatosis

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  Increased echogenicity: Liver more echogenic than kidney

  
  
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  Attenuation of US beam results in poor visualization of diaphragm

  
  
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  Blurry margins or poorly visualized hepatic and portal veins

Focal hepatic steatosis

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  Geographic hyperechoic area or multiple confluent hyperechoic lesions

  
  
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  No mass effect with vessels running undisplaced through lesion

  
  
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  Wedge-shaped/lobar/segmental distribution

Focal fatty sparing

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  Direct drainage of hepatic blood into systemic circulation

  
  
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  Gallbladder bed: Drained by cystic vein

  
  
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  Segment 4 or anterior to portal bifurcation: Drained by aberrant gastric vein

  
  
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  No mass effect with undisplaced vessel

Steatohepatitis

Fatty cirrhosis

Hemangioma

Metastasis or lymphoma

Nonalcoholic fatty liver disease may progress to nonalcoholic steatohepatitis, which may progress to fibrosis and cirrhosis

Cirrhosis is major risk factor for hepatocellular carcinoma

Look for undistorted vessels running through regions of steatosis

Ensure overall gain is set correctly; gain set too high can increase apparent echogenicity of liver and mimic steatosis