Solution: The findings here are the coarsened echotecture of the liver parenchyma with a nodular liver surface. Although there could in theory be similar findings with cirrhosis, there are also discrete mildly hyperechoic masses with hypoechoic halos as well if you look closely. This is consistent with diffuse metastatic disease with multiple considerations. Most common would probably be breast cancer in this patient population, but this patient ended up having a cecal adenocarcinoma.