Segment IV, immediately adjacent to the porta hepatis is the most common location for focal hepatic steatosis.
The ventral aspect of segment IV bordering the falciform ligament is another typical location, and commonly seen with cross-sectional imaging, but only occassionally with US. The likely explanation is that the superficial regions fall into the near field of convex transducers, where contrast resolution is significantly worse.
Focal fatty deposits showing the characteristic appearance and location can be followed with US, whilst for lesions showing atypical location or mass-like appearance, further evaluation with contrast-enhanced US is often warranted. CEUS can rule out malignancy with a specificity on par with cross-sectional imaging, is more cost-effective than MRI, and uses no ionizing radiation.