ABSTRACT Two-dimensional echocardiography is the most commonly used imaging modality for the diagnosis of heart disease. However, because of the physical properties of ultrasound waves, the interaction of ultrasound waves with tissues, and ultrasound equipment, echocardiographers are often confronted with ultrasound image artifacts. It is important to recognize such artifacts in order to avoid misinterpretation and misdiagnosis. The article summarizes the most common image artifacts encountered in routine clinical practice and their physical mechanisms, and how to avoid these artifacts and misdiagnoses.