Hepatic parenchymal echogenicity mostly indicates that the liver has parenchymal morphology changes, and the liver is suggestive of uneven density on imaging, showing diffuse echogenicity enhancement or attenuation. Nowadays, with the improvement of living standards, high cholesterol diet, obesity and lack of exercise, fatty infiltration of the liver is easily formed, and this fatty liver is most often shown on imaging as hepatic parenchymal echogenic inhomogeneity. Other lesions of the liver including various viral hepatitis, drug-related liver injury as well as alcoholic liver, cholestatic hepatitis, liver fibrosis, and autoimmune liver disease can cause hepatic parenchymal echogenicity. Multiple examinations should be performed to clarify the cause and take targeted treatment to prevent liver function from developing irreversibly.