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Parenchymal pseudolesions include focal fatty change, focal sparing, inflammatory pseudotumor, confluent fibrosis, pseudotumor hypertrophy and hepatic peliosis. Focal fatty changes are the most frequent of them. Approximately 30-40% of fatty liver infiltration cases occur focally, either as solitary areas, or as multiple areas with a more widespread distribution and lead to differential diagnosis with liver neoplasm. We present several cases of hepatic parenchymal pseudolesions, exemplified by 2D and contrast enhanced ultrasound imaging We report the case of a 72-year-old Caucasian man, who presented with a three- day history of right upper quadrant abdominal pain. He also complained of anorexia and significant weight loss in one month. The ultrasound exam showed an imprecisely- defined heterogeneous mass situated in his right hepatic lobe measuring 68 mm × 46 mm. Diffuse homogeneous hyperenhancement in the arterial phase and washout during the delayed phase was observed at contrast- enhanced ultrasound (CEUS), therefore malignancy was suspected. Because the MRI scan showed suspicious appearance of malignant lesion, liver biopsy was performed. Microscopic examination revealed nonspecific benign characteristics The metastatic work- up was also negative. After 3 months, the patient was in good condition. The case of a patient with neoplastic history and pseudotumoral fatty free infiltration and three other cases of atypical localisation of focal fatty infiltration or focal fatty sparing are also detailed. Non- neoplastic abnormalities are clearly depicted with modern imaging techniques such as CEUS. CEUS has high accuracy in the diagnosis of liver focal fatty infiltration or sparing. [ABSTRACT FROM AUTHOR]