Anatomic structures respond with characteristic features on ultrasound scanning.
There are some ultrasound terms, referring to the echo appearance, that describes tissue appearance in a uniform manner:

Tendons characteristically are hyperechoic on ultrasound because of the fibrillar pattern. Ligaments appear hyperechoic when the beam is perpendicular to the tissue. Peripheral nerves are hyperechoic relative to muscle.
Muscle appears relatively hypoechoic to tendon fibers. Close observation reveals hypoechoic muscle fibers separated by hyperechoic septae that converge on a hyperechoic aponeurosis. Articular hyaline cartilage appears hypoechoic. The presence of fluid within the joint outlining the cartilage produces a thin bright echo at this interface.
Sound beams do not penetrate the bone cortex. The very bright echo produced at the interface allows both recognition of the bone cortex but also can demonstrate fracture, spurring and bone callus bridging. Abnormal soft tissue calcification and ossification also produces bright reflective echoes.
Cysts or fluid filled areas are without internal echoes and are called echo free or anechoic and may demonstrate enhanced soft tissue echoes posterior to the fluid collection. Inflamed metatarsal bursae and calcaneal bursae clearly depict fluid swelling.

See also Beam Pattern and Zero Offset.

The third generation ultrasound contrast agents (UCA/USCA) are more echogenic and stable, and are able to enhance the echogenicity of parenchyma on B-mode images. These microbubbles may thus show perfusion, even in such a difficult region as the myocardium.

See also History of Ultrasound Contrast Agents.

Through diffraction and refraction on intersections edge acoustic shadowing can be created. The acoustic shadowing artifact is the loss of information below a dense object because the majority of the sound energy was reflected back by the object.
Shadowing artifacts occur if decreasing of the echo amplitude is not exponential with penetration depth caused by inhomogeneous tissue layers and fluid or air-filled regions. Bone, air, foreign bodies and calcification stop the transmission of sound waves producing a 'sonic shadow' which is a dark region distal to the echogenic obstructing region. This artifact occurs also in objects like e.g. prosthetic valves.

See also Boundary Layer, and Half-Value Layer.

Ultrasound waves are reflected when there is a change in acoustic impedance. The larger the change, the more ultrasound is reflected. Microbubbles have an enormous difference in acoustic impedance as compared to surrounding fluid due to the large differences in density, elasticity and compressibility.
At low acoustic power (mechanical index less than 0.1), the mechanism of ultrasound reflection is that of Rayleigh scattering and the microbubbles may be regarded as point scatterers. The scattering strength of a point scatterer is proportional to the sixth power of the particle radius and to the fourth power of the ultrasound frequency;; the echogenicity of such contrast agent is therefore highly dependent upon particle size and transmit frequency. The backscattered intensity of a group of point scatterers is furthermore directly proportional to the total number of scatterers in the insonified volume. The concentration of the contrast medium is of importance.

See also Backscatter Energy, Cross-section Scattering.

The dimension of the ultrasound beam and the transducer array are the origin of the beam width artifact or volume averaging artifact. When the ultrasound beam is wider than the diameter of the lesion being scanned, normal tissues which lie immediately adjacent to the lesion arc included within the beam width, and their echotexture is averaged in with that of the lesion.
Thus, what appears to be the echogenicity of the lesion is really that of the lesion plus the averaged normal tissues. Because of volume averaging, cystic lesions may falsely appear to be solid, and some subtle solid lesions may become impossible to distinguish from surrounding normal tissue and, therefore, not identified at all.

See also Ultrasound Picture and Vector Array Transducer.