Intrahepatic strong echogenicity usually refers to intrahepatic bile duct stones or intrahepatic calcified foci, but it is relatively difficult to distinguish intrahepatic calcified foci from intrahepatic bile duct stones, when a preliminary determination can be made by the alignment of the intrahepatic bile ducts. Intrahepatic bile duct stones, which may be stationary or isolated lesions, may also have caused bile duct stenosis or liver atrophy, mainly associated with recurrent biliary duct infections. In contrast, intrahepatic calcified foci may be the result of both congenital developmental abnormalities, abnormal calcium and phosphorus metabolism, or malnutrition. They may also be associated with trauma to the liver, inflammation, or even parasitic infection of the liver, primary liver cancer, or metastatic liver cancer, and need to be initially differentiated by liver ultrasound and, if necessary, further clarified by CT or MRI. For intrahepatic bile duct stones with clinical symptoms, or intrahepatic calcified foci in combination with parasitic infections or malignant tumors, prompt surgical treatment should be considered.