Small echogenic renal masses detected on ultrasound are most commonly angiomyolipoma (AMLs), however up to 5.1% of echogenic renal masses detected on ultrasound are renal cell carcinoma (RCC). While AMLs are the most common benign renal tumors, with prevalence between 0.2-0.6%. Most of these benign neoplasms are found incidentally on imaging and despite having smooth muscle, blood vessels, and adipose tissue, this is a heterogenous pathology. When AML contains little fat, they are isoechoic or only slightly hyperechoic on U/S and they can be mistaken for RCC.