Multiple focal liver lesions can generate diagnosis difficulties in daily practice. This paper present the case of a 53 years old patient with multiple hyperechoic liver lesions suggestive for hepatic hemangiomas, detected during the ultrasonographic exam. Contrast enhanced ultrasonography indicated focal hepatic steatosis, while computed tomography proposed possible liver metastasis. The histological diagnosis was focal nodular hyperplasia associated with hepatic steatosis. The peculiarity of the case was the association of multiple focal nodular hyperplasia lesions with hepatic steatosis and atypical imaging findings that required histological confirmation.