42 year old man was found to have hypercholesterolaemia and elevated liver enzymes on routine blood test. He is otherwise asymptomatic. Ultrasound showed fatty liver. These are characterised by generalised raised parenchymal echogenicity. The increased echogenicity is made relative to the renal parenchyma. It can be generalised or focal. Note the hepatic veins - there are less conspicuous than usual.