Different sound velocities in tissues are causing false distance artifacts. Ultrasound beams can suffer multiple reflections or specular reflections away from the sensor, giving false distance readings.

Reflection of the sound beam occurs when it hits a boundary between materials having different acoustic impedance. The reflection (echo) is the portion of a sound that is returned from the boundary. The reflection time (the time taken for the wave to return to the probe) can be used to determine the depth of the object.
The reflection within the body produces the ultrasound image, but should be minimized at an ultrasound couplant to skin boundary where the couplant acts as an acoustic window through which the image is seen. The amount of sound waves, which are reflected back at the interface between two tissues is depend on the angle of incidence and the difference between the acoustic impedance values of the two tissues.
If the difference is great, a large part of the sound waves will be reflected back. If too much sound is reflected back and not enough waves are remaining to be able to penetrate the tissue, the imaging will be poor.
If the difference is small, a small amount will be reflected back. Enough sound signal remains to continue with ultrasound imaging.
If the ultrasound beam meets a rough surface or small object, the beam is scattered in all directions and only a small amount will be received by the probe.

See also False Distance Artifact, Target Strength, and Snells Law.

The specular echo originates from relatively large, strongly reflective, regularly shaped objects with smooth surfaces. These intense reflections are angle dependent, and are described by reflectivity equation. This type of reflection is called specular reflection (i.e. IVS, valves).

See also False Distance Artifact, and Scattered Echo.