Dense parenchymal echogenicity of liver ultrasound is a manifestation of fatty liver. Generally, the normal liver fat content is 5%, and when the fat content exceeds 40%-50%, the liver echogenicity is dense. Causes of fatty liver include chronic infection and toxicity, obesity, endocrine disorders, diabetes mellitus, and alcoholic liver disease. In a typical fatty liver, the right and left lobes of the liver are echogenically dense, the intrahepatic vessels are thin and sparse, and the liver size can be normal or mildly to moderately enlarged. Generally, a right hepatic oblique diameter of more than 14 cm is considered an enlarged liver.