We studied ultrasonographic findings in nine patients with chronic hepatic porphyria. Seven of these patients had skin lesions characteristic of porphyria cutanea tarda, and the livers of all nine patients produced diffuse changes in parenchymal echoes that suggested the presence of chronic hepatitis, fibrosis, fatty change or cirrhosis, or other chronic liver disease associated with alcohol abuse, viral hepatitis, or both. Multiple nodular fatty infiltrations were detected in the livers of the two patients who had no skin lesions, and were confirmed on computed tomographic scan. Histologic findings were characteristic of chronic hepatic porphyria. Discovery of nodular fatty infiltrations through ultrasonographic examination is thus important in the diagnosis of chronic hepatic porphyria in patients without skin lesions.