A study was undertaken to evaluate the limitations of abdominal sonography in a group of predominantly elderly patients. In the majority of patients (98%) sonography, using 3.5 MHz and 5 MHz array transducers permitted visualization of the major abdominal organs with image quality sufficient for definitive diagnosis, but improved image quality would be desirable in 78% of this sample. Obesity and immobilization were associated with poor sonographic image quality. In 31 of the 45 (69%) poor image quality studies, no near-field artifacts (less than 3 cm depth) were observed. Obstacles in the acoustic path were noted in 77% of the poor image quality studies.