Report decoder
Understanding your ultrasound report
Radiology reports are written from one specialist to another, and patients read them in the corridor anyway. Look up the words calmly here, then take the actual interpreting to the doctor who ordered your scan.
23 report words, decoded.
How things look
- Echogenic / hyperechoic
- Reflects a lot of sound, so it appears bright on the image. Fat, calcium and some tissue patterns are naturally bright; "echogenic" describes appearance, not seriousness.
- Hypoechoic
- Reflects less sound than the tissue around it, so it appears darker. Many completely benign things are hypoechoic; the word is a description, not a verdict.
- Anechoic
- Reflects no sound at all and appears black. Simple fluid is anechoic, which is why a simple cyst looks like a neat black circle. Usually a reassuring word.
- Heterogeneous / homogeneous
- Mixed texture versus even texture. Organs are often described this way; "heterogeneous" alone does not mean disease, it means the texture varies and invites a closer look or comparison.
- Acoustic shadowing
- A dark stripe behind something that blocks sound, classically a gallstone or kidney stone. The shadow is often the clue that clinches the finding.
- Through-transmission / enhancement
- Brightening behind a fluid-filled structure because fluid lets sound pass easily. A classic feature of simple cysts, and generally a reassuring one.
Common findings
- Simple cyst
- A thin-walled sac of fluid. Simple cysts in the kidney, liver, ovary or thyroid are extremely common, usually harmless, and often need nothing beyond being noted.
- Complex cyst
- A cyst with extra features: internal echoes, walls or partitions (septations). "Complex" means "worth characterising further", which may just mean a follow-up scan.
- Nodule
- A small rounded area of tissue that stands out from its background, most often mentioned in the thyroid. Thyroid nodules are very common and the great majority are benign; reports often grade them and suggest whether anything more is needed.
- Lesion
- The most misread word in radiology: it simply means "an area that looks different". A cyst is a lesion; a birthmark is a lesion. The word itself carries no verdict.
- Calcification
- A small deposit of calcium, appearing bright and often shadowing. Very common with age and previous inflammation; the report will say if a pattern deserves attention.
- Hepatic steatosis (fatty liver)
- A liver storing more fat than usual, making it look brighter than the kidney beside it. Common, graded mild to severe, and importantly: often improvable with lifestyle changes, which is a conversation for your doctor.
- Free fluid
- Fluid lying loose in the belly or pelvis rather than inside an organ. A small amount can be normal (especially around ovulation); larger amounts always get explained in context.
- Hydronephrosis
- Swelling of a kidney's drainage system, suggesting urine is not draining freely, for example past a stone. Graded mild to severe; the ordering doctor decides what happens next.
Blood-flow words
- Doppler / colour flow
- The mode that shows movement, painting blood flow in colour on the image. "Normal colour flow" or "vascularity present" describes blood supply, and in most contexts normal flow is exactly what you want to read.
- Stenosis
- A narrowing, usually of an artery, often described with a percentage estimated from how fast blood squeezes through. What any percentage means for treatment is the referring doctor's conversation.
- Thrombus / DVT
- A blood clot. In leg vein scans the key phrases are about whether veins squash flat under the probe (compressible = no clot). "No evidence of DVT" is the all-clear phrase for that question.
Report phrases
- "Unremarkable"
- The best word a report can contain: examined, and nothing worth remarking on. Radiologists reserve their adjectives for things that matter; boring is beautiful.
- "Correlate clinically"
- A note from the radiologist to your doctor: match this picture with the symptoms, examination and blood tests. It flags shared reasoning, not a hidden problem.
- Incidental finding
- Something noticed while looking for something else, usually minor and very common (cysts, calcifications). Reports mention them for completeness; your doctor says whether any deserve follow-up.
- "Limited study" / "obscured by bowel gas"
- Honesty about physics: gas, bone or body habitus blocked part of the view. It does not mean something bad was seen; sometimes it means a repeat scan or a different test gives the missing view.
- "Suggest follow-up in X months"
- Watchful waiting, formalised: the finding looks low-risk, and re-checking its stability over time is often the safest, least invasive answer. Stability across scans is itself reassuring evidence.
- Measurements (mm and cm)
- Reports measure almost everything, and normal ranges depend on age, body size and context. Resist comparing your numbers with the internet's; compare them with your OWN previous scans, which is exactly what your doctors do.
The golden rule of reading your own report: the summary line (often called the impression or conclusion) is the radiologist's actual message. Everything above it is careful description, written for completeness, and it is where worried readers get lost. Read the conclusion, then bring the rest to your doctor.
Reviewed against RadiologyInfo.org (ACR / RSNA) and RCR plain-language guidance.
Sources
- Radiology glossary of terms RadiologyInfo.org (ACR / RSNA), 2024
- Ultrasound scan NHS, 2023
- Patient information: radiology reports The Royal College of Radiologists (RCR), 2023
Last reviewed: 2026-07-16
Before the next scan: see what each scan type can and cannot show and prepare properly.