Characterization of hyperechoic focal liver lesions in the abdominal ultrasound has always been a challenge for the radiologist. In this exhibit, we discuss and illustrate the sonographic features and differential diagnosis of various focal hepatic lesions which show hyper-echogenicity on ultrasound images. These include (1) malignant primary or secondary neoplasms (hepatocellular carcinoma, metastases), (2) benign neoplastic lesions (hepatic adenoma, hemangioma, angiomyolipoma), (3) non-neoplastic lesions (small hyperechoic hepatic lesions in patients with cirrhosis, benign regenerative nodules in Budd-Chiari syndrome and other vascular disorders of the liver, and inflammatory lesions). Familiarity with the sonographic features of these hyperechoic focal liver lesions can help ensure correct diagnosis and proper management.