A normal liver appears to be homogeneous and isoechoic. Hypoechoic nodules in the liver are usually considered as nodular hyperplasia, hepatocellular carcinoma and hepatic hemangioma. 1. Intrahepatic nodular hyperplasia: Focal nodular hyperplasia in the liver is usually hyperechoic. Its internal echogenicity is uniform or non-uniform. 2. Hepatocellular carcinoma: primary hepatocellular carcinoma is mostly hypoechoic, among which nodular hepatocellular carcinoma manifests as single or multiple hypoechoic or heterogeneous echogenic nodules in the liver, with dark rings around them. 3. Hepatic hemangioma: a few hepatic hemangiomas may also be characterized by hypoechoic nodules, and their borders are usually smooth and clear with regular morphology. Hypoechoic nodules in the liver should be diagnosed by combining clinical manifestations and other examinations.