Five patients with Wilson's disease with prognostically different hepatic manifestation were studied via ultrasound. Three of them presented histologically with fatty changes, fibrosis and interspersed areas of normal parenchyma. In these three patients, a peculiar ultrasound picture of the liver was observed which was quite different from the findings in the two others and which has not yet been recognized in the context of Wilson's disease. The parenchymal echo pattern was of increased echogenicity with numerous roundish foci of decreased echogenicity resembling metastatic liver disease. In contrast, the echo texture of the two patients with chronic active hepatitis leading to hepatic failure, was coarse, diffusely enhanced and without focal lesions. These findings indicate that ultrasound may help to define Wilson patients with good prognosis for the predominance of fatty changes and fibrosis in the liver.