BACKGROUND Liver metastases from head and neck cancer are rare (4.4%) and associated with a poor prognosis (median survival 4 months). The objective of the present study was to evaluate the radiological and biological features of liver metastases from head and neck (H and N) squamous cell carcinomas in 24 patients among 550 recurrent H and N cancer patients in our data bank. RESULTS At first presentation of liver nodules, liver enzyme levels (LEL) were found to be abnormal in 46% of patients (n = 11). Ultrasound features included miscellaneous presentations such as hypoechogenic (n = 21), hyperechogenic hemangioma-like lesions (n = 2), owl's eye (n = 2) or cyst-like liver nodules (n = 3). Hepatomegaly was present in 48% of the cases without any sign of portal hypertension and without any ascites. 1 month before death, all patients presented with abnormal LEL. Liver imaging showed an increase of 1.8x in size and of 2x in number of the tumor nodules. Hepatomegaly was present in 54%. Little ascites appeared in 2 cases, with no evidence of portal hypertension or liver insufficiency. Median disease-free interval and overall survival from recurrence were 10.8 and 4 months, respectively. CONCLUSION Ultrasound is convenient, cheap, without any side effect, and can provide additional information about liver metastases in H and N cancer patients. In patients with a history of H and N carcinoma ultrasound should be used to screen for isolated hepatic nodules even in the presence of normal liver function and if LDH elevation should be the only biological sign of alert.