Is grade 1 fatty liver serious?

Usually not on its own. Grade 1 is very common and describes how bright the liver looks, not how much damage there is. It is a sign to check liver tests, sugar and cholesterol, and it often improves with steady weight loss and less alcohol. It matters more if liver tests are raised or the liver also looks coarse.

Do gallstones need an operation if there is no pain?

Usually not. Most people with gallstones that cause no pain never have trouble from them. If you have had gallstone pain even once, see a surgeon, who will usually advise removing the gall bladder. A surgeon may also advise it in a few other situations, such as very large stones.

Is a simple kidney cyst cancer?

No. A simple renal cyst is a thin-walled bubble of clear fluid, very common after 50, and it does not turn into cancer. Only a cyst the report calls "complex" or "septated", or one with a Bosniak grade of IIF or higher, needs further tests.

My prostate is 30 cc. Is that a problem?

A prostate of 25–40 mL is common in men over 50. This kind of enlargement is not cancer, but an ultrasound cannot show whether there is cancer inside the prostate; that is what the PSA blood test is for. The size matters only if it causes trouble passing urine, or the bladder does not empty well. If you are over 50 and have never had a PSA test, ask about it at your next check-up.

Your ultrasound report, in plain words.

Most abdominal ultrasounds find something, and most of what they find is common and harmless. Here is what each phrase usually means, and when it needs a doctor.

Reviewed by Dr. Prabhat Arya, MBBS, MD (Internal Medicine)

Reviewed 18 October 2026 · Next review 18 October 2027 · Sources: MedlinePlus, NHS, NIDDK

Send your report for ₹199 See every value

Read this first.

An ultrasound (USG) uses sound waves, not radiation, to look at the liver, gall bladder, pancreas, spleen, kidneys, bladder and, in women, the womb and ovaries, or in men the prostate. The report lists each organ and ends with an Impression, which is the part to read first.

Ultrasound is very sensitive: it picks up small cysts, a little liver fat and tiny stones that many healthy adults have and never notice. Finding something is not the same as finding a disease. Sizes are typical adult sizes and vary with your height and build, and from one scan machine to another; go by what your own report calls normal.

The scan is best done after 6–8 hours without food, and with a full bladder for the lower tummy. Without fasting the gall bladder looks shrunken and its wall looks thick; with an empty bladder the prostate, womb and ovaries are hard to see.

Compare with any old scan. A stone or cyst that is the same size for years needs nothing. Take your old reports to every visit.

Every value, one by one.

Fatty liver, grade I, II or III (fatty infiltration, increased echogenicity of liver)
Hepatomegaly (enlarged liver), for example “liver 16.5 cm”
Coarse echotexture, nodular or irregular liver surface, or “features of chronic liver disease”
Simple hepatic cyst or haemangioma
Cholelithiasis, gallstones or calculus in the gall bladder
Gall bladder sludge or biliary sludge
Gall bladder polyp
Thickened gall bladder wall or gall bladder wall oedema
CBD (common bile duct), “dilated CBD”
Pancreas “obscured by bowel gas” or “not well visualised”
Splenomegaly (enlarged spleen)
Kidney size, for example “right kidney 10.2 cm”
Increased renal echogenicity, “medical renal disease” or poorly maintained corticomedullary differentiation
Renal calculus, nephrolithiasis or “concretion”
Hydronephrosis, hydroureteronephrosis or “back-pressure changes”
Simple renal cortical cyst
Prostatomegaly or prostate volume, for example “prostate 32 cc”
Post-void residual urine (PVR, residual urine)
Uterine fibroid, fibroid uterus, leiomyoma or “bulky uterus”
Simple ovarian cyst, follicular cyst or haemorrhagic cyst
Polycystic ovaries, PCOD or “bulky ovaries with peripheral follicles”
Free fluid, minimal ascites or fluid in the pouch of Douglas
Prominent or multiple mesenteric lymph nodes

Fatty liver, grade I, II or III (fatty infiltration, increased echogenicity of liver)

Fat stored inside the liver makes it look brighter on the scan

What it means: The most common finding on Indian ultrasound reports, seen in about one adult in three. The grade describes how bright the liver looks, not how much damage there is. It usually goes with weight around the waist, high sugar, high cholesterol or high BP, and sometimes alcohol. See fatty liver.
Usually nothing to worry about when: Grade I, with normal liver tests. It can shrink as weight comes down.
See a doctor when: At any grade, have liver tests, HbA1c and a lipid profile done this month, and a doctor can work out your risk of liver scarring (FIB-4 score). See a doctor within a week or two if the liver tests are raised or the report also mentions a coarse liver or large spleen.

Hepatomegaly (enlarged liver), for example “liver 16.5 cm”

The liver measures longer than usual

Typical adult range Up to about 15–16 cm long (more in tall people)

High usually means: Mild enlargement usually goes with fatty liver, alcohol or being tall. Recent viral fever, dengue, malaria and typhoid can enlarge it for a few weeks. Less often from heart failure or other liver disease.
Usually nothing to worry about when: It is just above the line, with fatty liver and normal liver tests.
See a doctor when: See a doctor within a week or two with your liver tests if it is more than mildly enlarged, or sooner if you have yellow eyes, fever or a swollen tummy.

Coarse echotexture, nodular or irregular liver surface, or “features of chronic liver disease”

The liver looks rough or lumpy instead of smooth

What it means: This can be a sign of long-standing liver damage and scarring (fibrosis or cirrhosis), from alcohol, hepatitis B or C, or fatty liver over many years. A slightly “coarse” look is sometimes over-read, so it needs other tests to confirm.
Usually nothing to worry about when: Never ignore this phrase, even if you feel well.
See a doctor when: See a doctor within one to two weeks for liver tests, platelet count, hepatitis B and C tests and usually a FibroScan. See hepatitis B and C.

Simple hepatic cyst or haemangioma

A small fluid bubble, or a small knot of blood vessels, in the liver

What it means: Both are common and harmless. A simple cyst is thin-walled and filled with clear fluid. A haemangioma is a small cluster of blood vessels present since birth; it is not a cancer and does not turn into one.
Usually nothing to worry about when: The report calls it “simple” or “typical haemangioma” and you have no liver disease.
See a doctor when: Only if the report says “complex”, “indeterminate”, “SOL” (space-occupying lesion) or suggests a CT or MRI: see a doctor within one to two weeks.

Cholelithiasis, gallstones or calculus in the gall bladder

Stones inside the gall bladder

What it means: Very common, especially in women and after 40. Most people with gallstones never have trouble from them. Typical gallstone pain is a severe ache under the right ribs or in the upper middle tummy, often after a meal, lasting from half an hour to several hours. See gallstones.
Usually nothing to worry about when: You have never had that pain. Stones that cause no symptoms usually need no operation.
See a doctor when: See a surgeon within a few weeks if you have had the pain, even once. A surgeon may also advise removal without pain in a few situations, such as very large stones (3 cm or more), a polyp, or a gall bladder wall that looks abnormal. Because gall bladder cancer is more common in North India, one visit to a surgeon to discuss silent stones is reasonable. Same day if the pain lasts more than a few hours, or comes with fever or yellow eyes.

Gall bladder sludge or biliary sludge

Thick bile settled at the bottom of the gall bladder

What it means: Seen after long fasting, during pregnancy, with fast weight loss and with some medicines. It often clears by itself; sometimes it forms stones later.
Usually nothing to worry about when: You have no tummy pain.
See a doctor when: If you get gallstone-type pain, see a doctor within a week; a repeat scan may be advised.

Gall bladder polyp

A small growth stuck to the inside wall of the gall bladder

What it means: Most are tiny and harmless, often deposits of cholesterol. Size decides what to do.
Usually nothing to worry about when: It is 5 mm or less: repeat ultrasounds at 6 months, 1 year and 2 years are usually enough, and can stop if it has not grown.
See a doctor when: See a surgeon within a few weeks if it is 6 mm or more, or has grown by 2 mm or more since the last scan. European guidance counts people of Indian origin as higher risk, so removal of the gall bladder is usually advised from 6 mm.

Thickened gall bladder wall or gall bladder wall oedema

The wall of the gall bladder measures thicker than usual

Typical adult range Wall up to about 3 mm when you have fasted

What it means: Most often because the scan was done without fasting, so the gall bladder had emptied and its wall bunched up. Other causes: inflammation from stones (cholecystitis), dengue (wall swelling is common and a sign of fluid leak), hepatitis, and liver, heart or kidney disease.
Usually nothing to worry about when: You had eaten before the scan and feel well; a repeat scan after fasting is usually normal.
See a doctor when: See a doctor today if it comes with fever and pain under the right ribs, or during a fever with low platelets (possible dengue); see dengue.

CBD (common bile duct), “dilated CBD”

The tube carrying bile from the liver to the gut

Typical adult range Up to about 6 mm (wider after gall bladder removal and in older people)

High usually means: A wide duct can mean a stone or something else blocking the flow of bile, especially with raised bilirubin or ALP.
Usually nothing to worry about when: It is just above 6 mm, you are older or have had your gall bladder removed, and your liver tests are normal.
See a doctor when: See a doctor within a few days with liver tests. Go to hospital today if it comes with yellow eyes, fever with shivering, or severe tummy pain.

Pancreas “obscured by bowel gas” or “not well visualised”

The radiologist could not see part of the pancreas

What it means: Gas in the bowel blocks sound waves, so the pancreas is often hidden, especially if you had not fasted. It means the organ was not seen, not that something is wrong with it.
Usually nothing to worry about when: You have no upper tummy pain going through to the back, no weight loss and no new diabetes.
See a doctor when: If you have those symptoms, see a doctor within a week; a CT scan may be needed instead.

Splenomegaly (enlarged spleen)

The spleen, on the left under the ribs, measures larger than usual

Typical adult range Up to about 12–13 cm long

High usually means: In India most often after an infection: malaria, dengue, typhoid or other viral fevers. Also with liver scarring, some anaemias and, less often, blood disorders.
Usually nothing to worry about when: It is mildly enlarged during or soon after a fever, and returns to normal on a later scan.
See a doctor when: See a doctor within a week with a blood count if there is no recent fever to explain it, or if it is large. Go to hospital today after any blow to the left side of the tummy.

Kidney size, for example “right kidney 10.2 cm”

The length of each kidney

Typical adult range About 9–12 cm long

Low usually means: Both kidneys small (under about 9 cm) usually means long-standing kidney disease. One small kidney with the other normal is often from birth or an old infection.
Usually nothing to worry about when: One kidney is a little smaller than the other but both are in range and your creatinine is normal.
See a doctor when: If both are small, or one is very small, check creatinine and eGFR and a urine test this week and see a doctor with the results.

Increased renal echogenicity, “medical renal disease” or poorly maintained corticomedullary differentiation

The kidneys look brighter, or their inner and outer layers are harder to tell apart

What it means: Can be a sign of kidney disease, often from diabetes or high BP. A mild change (“grade I”) is sometimes over-read and varies between scanners, so blood and urine tests decide.
Usually nothing to worry about when: Creatinine, eGFR and urine albumin are normal.
See a doctor when: Have creatinine, eGFR and urine albumin (ACR) checked within a week or two and see a doctor with the results. See kidney disease.

Renal calculus, nephrolithiasis or “concretion”

A stone in the kidney

What it means: Common in hot North Indian summers and in people who drink little water. A small stone sitting in the kidney often causes no pain; pain starts when it moves into the tube to the bladder. A “concretion” or “echogenic focus” is a tiny stone or calcium speck. See kidney stones.
Usually nothing to worry about when: It is under about 5 mm, causes no pain and the kidney is not swollen. Drinking enough to pass pale urine through the day helps.
See a doctor when: See a doctor within a week or two if the stone is 5 mm or more, you have had pain, you have stones on both sides, or keep forming new ones. Today if pain comes with fever or shivering.

Hydronephrosis, hydroureteronephrosis or “back-pressure changes”

The kidney is swollen because urine is not draining well

What it means: Something is slowing the flow of urine: a stone, an enlarged prostate, a narrowing, or in pregnancy the growing womb. Very mild fullness can be from a very full bladder at scan time.
Usually nothing to worry about when: It is “minimal” or “mild”, seen only with a very full bladder, and settles on a repeat scan after passing urine.
See a doctor when: See a doctor within a few days, with a kidney function test. Go to hospital today if it comes with fever, shivering or severe pain: a blocked, infected kidney is an emergency.

Simple renal cortical cyst

A thin-walled bubble of clear fluid on the kidney

What it means: Very common, and more common with age: about one in five people over 50 has one. A simple cyst is not cancer, does not turn into cancer and does not harm the kidney.
Usually nothing to worry about when: The report says “simple”. It usually needs no treatment and no further test.
See a doctor when: Only if the report says “complex”, “septated”, “Bosniak II F or higher”, or suggests a CT: see a doctor within two to four weeks. Many cysts in both kidneys, especially with a family history, is a different condition (polycystic kidney disease) and needs a doctor within a few weeks.

Prostatomegaly or prostate volume, for example “prostate 32 cc”

The size of the prostate gland below the bladder (men)

Typical adult range Under about 25 mL (cc) in younger men; it grows with age

High usually means: An enlarged prostate is very common after 50 and is not cancer; it does not raise the risk of cancer. It matters only if it causes symptoms: a weak stream, straining, getting up at night to pass urine, or feeling the bladder has not emptied.
Usually nothing to worry about when: It is mildly enlarged and you have no trouble passing urine.
See a doctor when: See a doctor within a few weeks if you have urine symptoms, or to discuss a PSA test. See a doctor within a day or two if there is blood in the urine or pain on passing urine.

Post-void residual urine (PVR, residual urine)

How much urine stays in the bladder after you have passed urine

Typical adult range Under about 50 mL

High usually means: A higher amount means the bladder is not emptying fully, most often from an enlarged prostate in men, or from diabetes affecting bladder nerves or some medicines. A few hundred mL is significant.
Usually nothing to worry about when: It is under 100 mL and you have no symptoms; it varies from scan to scan, and being rushed raises it.
See a doctor when: See a doctor within one to two weeks if it is over about 100–150 mL or you have urine symptoms; sooner if it is several hundred mL.

Uterine fibroid, fibroid uterus, leiomyoma or “bulky uterus”

A firm, non-cancerous lump of muscle in or on the womb (women)

What it means: Very common in women in their 30s and 40s, and usually harmless. They often shrink after the menopause. “Bulky uterus” means a slightly larger womb, common after children or with fibroids or adenomyosis.
Usually nothing to worry about when: You have no heavy or painful periods and no pressure symptoms. Fibroids that cause no symptoms usually need no treatment.
See a doctor when: See a gynaecologist within a few weeks if you have heavy or long periods, pain, pressure on the bladder, trouble getting pregnant, or a fibroid that grows after the menopause.

Simple ovarian cyst, follicular cyst or haemorrhagic cyst

A fluid bubble on an ovary (women)

What it means: Before the menopause most are part of the normal monthly cycle and go away by themselves within one to three cycles. A “haemorrhagic” cyst has a little blood in it and also usually settles.
Usually nothing to worry about when: You are before the menopause, the cyst is called simple, and it is not large.
See a doctor when: A repeat scan after 6–12 weeks is often advised for larger cysts. After the menopause, or if the report says “complex” or “solid component”, see a gynaecologist within two weeks.

Polycystic ovaries, PCOD or “bulky ovaries with peripheral follicles”

Many small follicles around the edge of the ovaries (women)

What it means: This look is common in young women with normal cycles. On its own it is not a diagnosis: PCOS (polycystic ovary syndrome) also needs irregular periods or signs of raised male hormones such as acne or extra facial hair, and blood tests.
Usually nothing to worry about when: Your periods are regular and you have no acne or extra hair growth.
See a doctor when: With irregular periods, weight gain, acne or extra hair, see a doctor within a few weeks for sugar, hormone and cholesterol tests.

Free fluid, minimal ascites or fluid in the pouch of Douglas

A small amount of fluid in the tummy or pelvis

What it means: A small amount in the pelvis is normal in women around ovulation. Elsewhere, or more than a little, it has a cause: dengue (fluid leak), liver scarring, heart or kidney disease, infection such as TB, or less often a growth.
Usually nothing to worry about when: It is “minimal”, only in the pelvis, in a woman in the middle of her cycle.
See a doctor when: See a doctor within a few days for any other free fluid. During a fever with low platelets, see a doctor today. If you could be pregnant (a late or missed period) and have pain low in the tummy, go to hospital now.

Prominent or multiple mesenteric lymph nodes

Small glands in the fold of tissue that holds the bowel

What it means: Small nodes are common in young people, especially after a tummy infection or loose motions, and settle by themselves. Larger or matted nodes can be from abdominal TB in India.
Usually nothing to worry about when: They are small (the report says under about 10 mm) or called “reactive”, and you are well.
See a doctor when: See a doctor within a week or two if they are large or matted, or you have tummy pain with fever, night sweats or weight loss.

Results that go together.

PatternsTypical, not certain

When you see	It usually means
Grade I or II fatty liver with mild hepatomegaly, raised SGPT and high triglycerides	The usual picture of fatty liver from extra weight and sugar. Weight loss is the main treatment; see fatty liver.
Coarse liver, enlarged spleen and free fluid	Suggests scarring of the liver (cirrhosis). See a doctor within a few days.
Gallstones with a dilated CBD and raised bilirubin or ALP	A stone may have slipped into the bile duct. See a doctor within a day; today if you have fever or yellow eyes.
Kidney stone with hydronephrosis on the same side	The stone is blocking the flow of urine. See a doctor within a few days; today if there is fever or shivering.
Enlarged prostate with a high post-void residual and back-pressure changes	The prostate is blocking the bladder. See a doctor within a few days with a kidney test.
Gall bladder wall oedema, free fluid and an enlarged liver during a fever	Typical of dengue with fluid leak. Go to hospital today; see dengue.

Get help today if

Severe tummy pain lasting more than a few hours, with fever, shivering or yellow eyes, and a report of gallstones, a dilated CBD or hydronephrosis: go to hospital today.
Fever with shivering and a blocked kidney (hydronephrosis with a stone): go to hospital now; this needs draining quickly.
Unable to pass urine at all, with a painful swollen lower tummy: go to hospital now.
Sudden severe pain low on one side in a woman with an ovarian cyst, especially with vomiting or fainting: go to hospital now, or call 112.
Vomiting blood or passing black stools with a report of chronic liver disease or cirrhosis: call 112 or go to hospital now.

Call 112 or go to the nearest emergency department. Ambulance: 108 (102 in some states).

Questions people ask.

Is grade 1 fatty liver serious?
Usually not on its own. Grade 1 is very common and describes how bright the liver looks, not how much damage there is. It is a sign to check liver tests, sugar and cholesterol, and it often improves with steady weight loss and less alcohol. It matters more if liver tests are raised or the liver also looks coarse.
Do gallstones need an operation if there is no pain?
Usually not. Most people with gallstones that cause no pain never have trouble from them. If you have had gallstone pain even once, see a surgeon, who will usually advise removing the gall bladder. A surgeon may also advise it in a few other situations, such as very large stones.
Is a simple kidney cyst cancer?
No. A simple renal cyst is a thin-walled bubble of clear fluid, very common after 50, and it does not turn into cancer. Only a cyst the report calls “complex” or “septated”, or one with a Bosniak grade of IIF or higher, needs further tests.
My prostate is 30 cc. Is that a problem?
A prostate of 25–40 mL is common in men over 50. This kind of enlargement is not cancer, but an ultrasound cannot show whether there is cancer inside the prostate; that is what the PSA blood test is for. The size matters only if it causes trouble passing urine, or the bladder does not empty well. If you are over 50 and have never had a PSA test, ask about it at your next check-up.

Where this can be checked

These are trusted general sources. The advice on this page is Dr. Arya’s, written for patients in India. Ranges differ between labs: go by the range printed on your own report.

Your whole report, read by your doctor.

Send every page, old reports too. He reads them himself and tells you what changed and what to do.

Send your report for ₹199

Dr. Prabhat Arya · MBBS, MD (Internal Medicine)

Liver	15.8 cm · Grade I fatty	H
Gall bladder	Single calculus 9 mm
CBD	4 mm
Right kidney	Simple cortical cyst 12 mm
Left kidney	10.4 cm · No calculus
Prostate	28 mL	H