Real-time abdominal sonograms of 27 pediatric patients with cystic fibrosis were reviewed to determine the frequency of hepatobiliary abnormalities and their variation with patient age. Attention was paid to hepatic echotexture and gallbladder size and contents. Seventeen patients (63%) had abnormal livers appearing as diffuse hyperechogenicity with loss of visualization of periportal echoes in 5 of 17 patients (29%), periportal hyperechogenicity in 9 of 17 (53%) and heterogeneity in 3 of 17 (17%). Gallbladder abnormalities, including a small gallbladder and sludge, were found in 9 patients (33%). Our findings show that altered hepatic echotexture is quite common in children with cystic fibrosis. Younger children tend to have diffusely hyperechoic livers, while older children often demonstrate periportal hyperechogeneity or diffuse hepatic heterogeneity.