Comparative echogenicity of liver, kidney and spleen in cats
9-year-old neutered female Domestic Shorthair, obese, with 10 days of anorexia and mild jaundice. On ultrasound the liver is enlarged, with rounded margins and more echogenic than the falciform fat; the renal cortex is more echogenic than the liver usually is in other cats. Ultrasound image of the liver:
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Which interpretation is most appropriate?
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A. The hyperechoic renal cortex confirms advanced chronic kidney disease
In cats the renal cortex can normally be iso- or hyperechoic to the liver because of lipid vacuoles in tubular cells, especially in obese cats. On its own it does not diagnose kidney disease.
B. The normal liver is more echogenic than the spleen, so this finding is normal
The normal order is the opposite: the spleen is the most echogenic parenchyma, and the liver is hypo- or isoechoic to it. A liver brighter than the falciform fat is not normal.
C. An enlarged liver that is hyperechoic to the falciform fat is consistent with hepatic lipidosis; a bright renal cortex may be normal in cats
Correct. In an obese, anorexic cat, hepatomegaly with a liver iso- or hyperechoic to the falciform fat suggests lipidosis, which is confirmed by cytology. Renal cortical hyperechogenicity is non-specific in cats and may reflect physiological tubular fat.
D. To compare echogenicity it is enough to view each organ in separate images with the gain adjusted for each
Echogenicity is relative: organs must be compared in the same image, at the same depth and with the same gain. Adjusting the gain separately invalidates the comparison.
lightbulb Key takeaway
Usual order of echogenicity, from lowest to highest: renal medulla < renal cortex < liver < spleen < renal sinus/fat. In cats the renal cortex may normally be hyperechoic, and the falciform fat is a good reference for the liver. Always compare in the same image and at the same depth.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.