Unevenness of echo is a term often used in ultrasound reports and is considered to be related to physiologic and pathologic factors. 1. Physiologic factors: In general, if a patient has an occasional ultrasound that suggests a thick endometrium with uneven internal echoes, this does not indicate a pathologic condition and may be related to an examination error. 2. Pathologic factors: The lack of uniformity of echoes can often be used to describe the internal echoes of an organ or a space-occupying lesion. A description of heterogeneous echoes in a particular organ indicates that the organ may have internal structural changes of some etiologic origin, which are abnormal. If the ultrasound examination reveals a space-occupying lesion, the description of the lesion with inhomogeneous internal echoes does not rule out the possibility that it is related to a benign or malignant tumor. In case of abnormal imaging findings in clinical practice, it is recommended to consult a doctor to clarify the cause of the disease and to carry out targeted management or treatment.