Involvement of liver in leprosy is well documented which is reflected in the serological investigations however liver biopsy was the only source to interpret the pathology of liver in leprosy.  Noninvasive techniques like ultrasonography have shown gross inhomogenous echotexture of the hepatic parenchyma in lepromatous leprosy and milder involvement of liver in tuberculoid leprosy.  Tuberculoid granulomas in the liver of leprosy patients during the reactive phase have been well described on ultrasonography. Our aim is to study and compare the structural abnormalities of liver during various stages of leprosy using a safe and non–invasive procedure like Ultrasonography. In this study we observed that echogenicity and echotexure is grossly affected in multibacillary than paucibacillary leprosy patients but liver size enlargement and fatty changes were seen in Type I and type II reactions respectively in very few cases. We conclude that Ultrasonography is noninvasive, handy and easily available technique in resource limited settings to detect gross hepatic involvement in patients of leprosy and to some extent replace the invasive liver biopsy technique for the same purpose but with certain limitations.