Objective To explore the clinical value of real time contrast-enhanced ultrasound in diagnosis of liver localized fatty deletion and fatty infiltration which couldn't be confirmed by conventional ultrasonography. Methods Contrast-enhanced ultrasound was performed on 94 patients with liver localized diseases confirmed by baseline sonography, among them 34 patients with liver localized fatty deletion and fatty infiltration were enrolled. Results Contrast-enhanced ultrasonography didn't show apparent occupancy nidus in 34 patients. Enhancement mode of lesions was the same as liver parenchyma, which was distinctly different from liver occupancy diseases. Conclusion Real time contrast-enhanced ultrasound can display typical signs of liver localized fatty deletion and fatty infiltration and has significant value in diagnosis and differentiating diagnosis of them.